Provider Demographics
NPI:1528954195
Name:TULLY, JESSICA ALLANE (CD/PCD(DONA), CLC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ALLANE
Last Name:TULLY
Suffix:
Gender:F
Credentials:CD/PCD(DONA), CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3031
Mailing Address - Country:US
Mailing Address - Phone:908-963-8644
Mailing Address - Fax:
Practice Address - Street 1:6 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3031
Practice Address - Country:US
Practice Address - Phone:908-963-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310990174N00000X
IL13763374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN