Provider Demographics
NPI:1184798449
Name:FETT, JESSICA ANGELA NICHOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANGELA NICHOLE
Last Name:FETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3372
Mailing Address - Country:US
Mailing Address - Phone:860-253-9024
Mailing Address - Fax:860-253-9593
Practice Address - Street 1:5 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3372
Practice Address - Country:US
Practice Address - Phone:860-253-9024
Practice Address - Fax:860-253-9593
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280255363L00000X
CT003542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT103542OtherCONNECTICARE
CT1255448155OtherGHMC GROUP NPI
CT3V0058OtherHEALTH NET
CT004264529Medicaid
CT103542OtherCONNECTICARE
CT1255448155OtherGHMC GROUP NPI