Provider Demographics
NPI:1447014956
Name:DINGUS, JESSICA LILLIEFAYE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LILLIEFAYE
Last Name:DINGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HALL RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9045
Mailing Address - Country:US
Mailing Address - Phone:937-690-9160
Mailing Address - Fax:
Practice Address - Street 1:3900 RHODES AVE APT 509
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-4958
Practice Address - Country:US
Practice Address - Phone:740-935-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402000960817374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide