Provider Demographics
NPI:1679985683
Name:DEMUMBREUM, JESICA (MSN, PMHNP-BC, IBCLC)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:DEMUMBREUM
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 J.N. PLEASE PLACE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-817-8230
Mailing Address - Fax:704-665-5645
Practice Address - Street 1:1977 J N PEASE PL STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4527
Practice Address - Country:US
Practice Address - Phone:704-817-8230
Practice Address - Fax:704-665-5645
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-24
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health