Jessica Jane Bornemann, R.N.
Individual provider Active NPI Registered Nurse · Rocky Point, NY
NPI 1013346824 · NPPES record last updated Nov 2, 2013
Key facts
- NPI
- 1013346824
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 673216-1 (NY)
- Practice address
- 71 Cherry Rd
Rocky Point, NY 11778-8827 - Phone
- (631) 875-8821
- NPI assigned
- Nov 2, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 673216-1 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 673216-1 | NY | Yes |
Addresses
Primary practice location
71 Cherry Rd
Rocky Point, NY 11778-8827
Mailing address
71 Cherry Rd
Rocky Point, NY 11778-8827
Phone (631) 875-8821
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 673216-1 | Medicaid | NY |
Other providers in Rocky Point, NY
- Johanna Bissell
- Jeannette A Blaha
- Diane M Blake
- Elizabeth Kathleen Bonner
- Kaitlyn Margaret Bonser
- Valerie Brandow
- Annette Brasor
- Kenneth Arthur Brown
- Jennifer Marie Bruno
- Katherine Buchler
All providers in Rocky Point, NY · Registered Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.