Provider Demographics
NPI:1316762008
Name:PURDIN, JESSICA HAZEL (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HAZEL
Last Name:PURDIN
Suffix:
Gender:X
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HAZEL
Other - Last Name:LOUIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:25800 INDUSTRIAL BLVD # V3367
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2935
Mailing Address - Country:US
Mailing Address - Phone:858-232-2365
Mailing Address - Fax:
Practice Address - Street 1:25800 INDUSTRIAL BLVD # V3367
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2935
Practice Address - Country:US
Practice Address - Phone:858-232-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953688012084P0800X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry