Individual
JESSICA VANNEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
500 MAIN ST, BUILDING 2, LANOKA HARBOR, NJ 08734-2228
(732) 581-6758
(732) 358-0284
Mailing address
117 OAK ST, FORKED RIVER, NJ 08731-4219
(732) 581-6758
(732) 358-0284
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
46TR00290300
NJ
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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