Provider Demographics
NPI:1770951899
Name:GALE, JESSICA LYNN I (LPN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:GALE
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-1735
Mailing Address - Country:US
Mailing Address - Phone:607-972-6392
Mailing Address - Fax:
Practice Address - Street 1:42 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-1735
Practice Address - Country:US
Practice Address - Phone:607-972-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10323300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse