1053553800 NPI number — JESSICA L BOORE RDH

Table of content: JESSICA L BOORE RDH (NPI 1053553800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053553800 NPI number — JESSICA L BOORE RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOORE
Provider First Name:
JESSICA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNBAR
Provider Other First Name:
JESSICA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053553800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 S GEORGE ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17401-1474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-846-5846
Provider Business Mailing Address Fax Number:
717-854-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 S GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17401-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-845-8617
Provider Business Practice Location Address Fax Number:
717-718-1317
Provider Enumeration Date:
03/25/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  DH069972 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 124Q00000X , with the licence number: PHDH000381 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)