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Individual
JESSICA MCCOLLISTER
Active
Individual
JESSICA MCCOLLISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
318963
NY
251E00000X
Home Health Agency
318963
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318963
—
NY
Enumeration date
07/22/2014
Last updated
09/17/2015
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