Provider Demographics
NPI:1124285408
Name:JESSEN, MARGIE LYNN
Entity type:Individual
Prefix:MS
First Name:MARGIE
Middle Name:LYNN
Last Name:JESSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0351
Mailing Address - Country:US
Mailing Address - Phone:559-324-7520
Mailing Address - Fax:
Practice Address - Street 1:7025 N CHESTNUT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0351
Practice Address - Country:US
Practice Address - Phone:559-324-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist