Provider Demographics
NPI:1053562934
Name:CHICHESTER, JESSICA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CHICHESTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:RICHMONDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12149-0099
Mailing Address - Country:US
Mailing Address - Phone:518-294-6054
Mailing Address - Fax:518-294-6870
Practice Address - Street 1:163 WELLER RD
Practice Address - Street 2:
Practice Address - City:RICHMONDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12149-2201
Practice Address - Country:US
Practice Address - Phone:518-294-6054
Practice Address - Fax:518-294-6870
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278412164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse