Individual
MS. JESSICA ROBIN VANNAME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
630 W 168TH ST, NEW YORK, NY 10032-3725
(212) 305-2500
Mailing address
509 E 78TH ST APT 5C, NEW YORK, NY 10075-1114
(845) 222-8308
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
027739
NY
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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