Provider Demographics
NPI:1598587511
Name:UPSHAW, JESSICA N (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:UPSHAW
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 1:1560 N COLE ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2433
Mailing Address - Country:US
Mailing Address - Phone:419-905-6301
Mailing Address - Fax:
Practice Address - Street 1:1106 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3402
Practice Address - Country:US
Practice Address - Phone:419-604-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN184121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse