Provider Demographics
NPI:1285290213
Name:RULE, JESSICA MARIAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIAN
Last Name:RULE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1373
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:CA
Mailing Address - Zip Code:92386-1373
Mailing Address - Country:US
Mailing Address - Phone:575-693-2366
Mailing Address - Fax:
Practice Address - Street 1:41947 BIG BEAR BLVD
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-878-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant