Provider Demographics
NPI:1902130164
Name:MACALUSO, JESSICA ERIN (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16671 NW DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1895
Mailing Address - Country:US
Mailing Address - Phone:503-746-7404
Mailing Address - Fax:
Practice Address - Street 1:16671 NW DUBLIN CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1895
Practice Address - Country:US
Practice Address - Phone:503-746-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200930404LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse