Provider Demographics
NPI:1710555412
Name:VANOVER, JESSICA LORRAINE (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:VANOVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 WOODEN HORSE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-6502
Mailing Address - Country:US
Mailing Address - Phone:502-741-2983
Mailing Address - Fax:
Practice Address - Street 1:3001 N HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2209
Practice Address - Country:US
Practice Address - Phone:502-420-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1168448163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse