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NPI Code Detail

MEDICARE: MR. JON EARL DITMARS LPN

MEDICARE:  MR. JON EARL DITMARS  LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse121292OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467644088
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JON EARL DITMARS LPN
Provider Business Mailing Address
First Line : 655 S OAKLEY AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-2920
Country : US
Telephone Number : 614-351-1408
Fax Number :
Provider Business Practice Location Address
First Line : 655 S OAKLEY AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-2920
Country : US
Telephone Number : 614-351-1408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2007
Last Update Date : 08/16/2007

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Directions to “ MR. JON EARL DITMARS LPN” Practice Location

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