Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 22415 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 22415 | SC |
NPI | 1053514612 |
---|---|
Provider Name | Mrs. Jessica Leigh Ionno |
First Address | Little River, SC 29566-0547 |
Second Address | Murrells Inlet, SC 29576-7812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 16/06/2021 |