Provider Demographics
NPI:1306621370
Name:FAIRCLOUGH, JESSICA ELIZABETH
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:FAIRCLOUGH
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 1:246 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1624
Mailing Address - Country:US
Mailing Address - Phone:507-319-4534
Mailing Address - Fax:
Practice Address - Street 1:246 8TH ST NE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1624
Practice Address - Country:US
Practice Address - Phone:507-319-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker