Individual ProviderJessica BassLicensed Practical NurseNursing Service ProvidersPractice Address11 Pondview Dr Apt 4, East Patchogue, NY 11772-6854(631) 617-9523PECOS EnrollmentBased on the most recent information from CMS, provider Jessica Bass does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1790189314Provider TypeIndividualFull NameBass, JessicaCredentialLPNGenderFemaleSole ProprietorNoEnumeration Date10/9/2014Last Updated10/9/2014Contact InformationPractice LocationPractice Address11 Pondview Dr Apt 4, East Patchogue, NY 11772-6854Phone(631) 617-9523FaxUnlisted FaxMailing LocationMailing Address11 Pondview Dr Apt 4, East Patchogue, NY 11772-6854Phone(631) 617-9523FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense316007-1New York