Basic Information
Provider Information
NPI: 1245606490
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLURSCHUTZ
FirstName: JESSIE
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SHEFLER
OtherFirstName: JESSIE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: NP
OtherLastNameType: 1
Mailing Information
Address1: 33 LEWIS RD
Address2: 2ND FL
City: BINGHAMTON
State: NY
PostalCode: 13905
CountryCode: US
TelephoneNumber: 6077298156
FaxNumber:  
Practice Location
Address1: 30 HARRISON ST STE 250
Address2:  
City: JOHNSON CITY
State: NY
PostalCode: 137902176
CountryCode: US
TelephoneNumber: 6077708600
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/11/2015
LastUpdateDate: 11/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X339807NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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