Provider Demographics
NPI:1376426247
Name:BIRBECK, JESSICA (RN, SANE-A)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BIRBECK
Suffix:
Gender:F
Credentials:RN, SANE-A
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MARGERUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1325
Mailing Address - Country:US
Mailing Address - Phone:267-266-7937
Mailing Address - Fax:
Practice Address - Street 1:NURSING SCIENCES BLDG
Practice Address - Street 2:235 E COLLEGE AVE
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:267-266-7937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN596979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse