Jessica Lynn Rose
Contractor in Canton, NY. Individual provider (NPI-1).
NPI number1104565019
StatusActive
Last updated in NPPESMay 31, 2022
Details
- NPI
- 1104565019
- Entity type
- Individual (NPI-1)
- Name
- Jessica Lynn Rose
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 31, 2022
- Certification date
- May 31, 2022
- Last updated
- May 31, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
Practice location
80 State Highway 310 Ste 2Canton, NY 13617-1436
Phone 315-386-2325
Mailing address
80 State Highway 310 Ste 2Canton, NY 13617-1436
Phone 315-386-2325
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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