Provider Demographics
NPI:1154791606
Name:MCMAHON, JESSICA L (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MCMAHON
Suffix:
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 1:24 BROOKHILL DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1301
Mailing Address - Country:US
Mailing Address - Phone:302-454-3020
Mailing Address - Fax:
Practice Address - Street 1:2113 NAAMANS RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-1326
Practice Address - Country:US
Practice Address - Phone:302-740-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0010771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse