Provider Demographics
NPI:1447660139
Name:ZUMACK, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ZUMACK
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 1:12420 WANDEL RD
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44235-9736
Mailing Address - Country:US
Mailing Address - Phone:330-416-7212
Mailing Address - Fax:
Practice Address - Street 1:76 N HIGH ST.
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273
Practice Address - Country:US
Practice Address - Phone:330-769-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401464231212376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide