Provider Demographics
NPI:1063699932
Name:MONTECINO, JESSICA T (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:MONTECINO
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 1:2 CENTER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3080
Mailing Address - Country:US
Mailing Address - Phone:973-901-1187
Mailing Address - Fax:
Practice Address - Street 1:2 CENTER ST APT 1
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3080
Practice Address - Country:US
Practice Address - Phone:973-901-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08117800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse