Provider Demographics
NPI:1124736087
Name:JESSEN, ALLYSON MARIE (APRN, AGPCNP)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MARIE
Last Name:JESSEN
Suffix:
Gender:F
Credentials:APRN, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 N ROSE ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2734
Mailing Address - Country:US
Mailing Address - Phone:818-391-6371
Mailing Address - Fax:
Practice Address - Street 1:4770 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1136
Practice Address - Country:US
Practice Address - Phone:718-931-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311064363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health