Provider Demographics
NPI:1053514612
Name:IONNO, JESSICA LEIGH (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:IONNO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:LIESVELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8013
Mailing Address - Fax:843-663-8166
Practice Address - Street 1:912 INLET SQUARE DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7812
Practice Address - Country:US
Practice Address - Phone:843-651-4111
Practice Address - Fax:843-492-4666
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22415176B00000X, 363LF0000X
NJ26NJ00281700363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health