Provider Demographics
NPI:1699051011
Name:HORNICKELL, JESSICA LYNNE I (CNA)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNNE
Last Name:HORNICKELL
Suffix:I
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POOL ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2877
Mailing Address - Country:US
Mailing Address - Phone:717-639-1484
Mailing Address - Fax:
Practice Address - Street 1:3 BRAZIER LN
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7095
Practice Address - Country:US
Practice Address - Phone:207-985-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10013724376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide