Basic Information
| Provider Information | |||||||||
| NPI: | 1942875018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 DIAMOND ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018432033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783907982 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 GRIFFIN BROOK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018441865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786896523 | ||||||||
| FaxNumber: | 9786810459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2021 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2351086 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.