Jessica Carolyn Clark Manderville, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

643474 Issued in NY

Practice address

55 Brown Rd
Ithaca, NY 14850-1247

Phone

(607) 274-6600

NPI assigned

Nov 3, 2021

Last updated

Nov 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1750046843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 BROWN RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 BROWN RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501247",
            "telephone_number": "607-274-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK MANDERVILLE",
        "first_name": "JESSICA",
        "middle_name": "CAROLYN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "643474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janessa Ciaschi, LMSW
• Isabella Marie Cicconi
• Nichole Cipparuolo
• Mary Catherine Clapp, NP
• Clare Joanne Nicholetti, LCSW
• Debra E Clark, PH.D.
• Mitzi D Clark, DVM
• Rachel L Clark, NP-C
• William Ray Clark Jr., PHARM D
• Lisa Marie Clauson, FNP

• Registered Nurse in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.