Provider Demographics
NPI:1023307303
Name:ORBAN, JESSIE L (CRNA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:ORBAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 HARRIMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2500
Mailing Address - Country:US
Mailing Address - Phone:610-972-9859
Mailing Address - Fax:
Practice Address - Street 1:934 HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2500
Practice Address - Country:US
Practice Address - Phone:610-972-9859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179296367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered