Provider Demographics
NPI:1679309942
Name:GARCIA, JESSICA R
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S WEBB RD # 4904
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5110
Mailing Address - Country:US
Mailing Address - Phone:308-385-5900
Mailing Address - Fax:
Practice Address - Street 1:123 S WEBB RD # 4904
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5110
Practice Address - Country:US
Practice Address - Phone:308-385-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24740164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse