Provider Demographics
NPI:1124339981
Name:MCLAUGHLIN, JESSICA I (LPN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:I
Last Name:MCLAUGHLIN
Suffix:
Gender:
Credentials:LPN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:I
Other - Last Name:KOZMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7867 LANCEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090
Mailing Address - Country:US
Mailing Address - Phone:315-480-0470
Mailing Address - Fax:
Practice Address - Street 1:7867 LANCEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090
Practice Address - Country:US
Practice Address - Phone:315-480-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273824-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03236000Medicaid