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1003578402
JESSICA LEE CORNELIUS
FARGO, ND
NPI
1003578402
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Former Name
JESSICA LEE PUCKETT
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2021-10-13
Last Update Date
2021-10-13
Business Address
JESSICA LEE CORNELIUS
629 21ST ST S APT 4
FARGO, ND 58103-2487
Phone number: 701-353-9257
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Mailing Address
JESSICA LEE CORNELIUS
2201 6TH AVE S
FARGO, ND 58103-2411
Phone number: 701-515-8117
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