National Provider Identifier
Jessica Carolyn Clark Manderville, RN
Jessica Carolyn Clark Manderville, RN is listed in the NPPES registry with a primary specialty of Registered Nurse in Ithaca, NY and a listed phone number of (607) 274-6600.
Profile Overview
- NPI
- 1750046843
- Provider Type
- Individual
- Primary Specialty
- Registered Nurse
- Enumeration Date
- November 03, 2021
- Last Updated
- November 03, 2021
Practice Location
- 55 Brown RD
- Ithaca, NY 14850-1247
Phone: (607) 274-6600
Specialties
- Registered Nurse (163W00000X)
Full Record
- NPI
- 1750046843
- Entity Type
- Individual
- Last Name
- Clark Manderville
- First Name
- Jessica
- Middle Name
- Carolyn
- Credential
- RN
- Mailing Street Address
- 55 Brown RD
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-1247
- Mailing Country
- US
- Practice Street Address
- 55 Brown RD
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-1247
- Practice Country
- US
- Practice Phone
- (607) 274-6600
- Enumeration Date
- November 03, 2021
- Last Updated
- November 03, 2021
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- November 03, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Registered Nurse (163W00000X)