Healthcare Provider Details

I. General information

NPI: 1477010130
Provider Name (Legal Business Name): JASON ALLEN ATWELL CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 BUCYRUS RD
GALION OH
44833-1509
US

IV. Provider business mailing address

839 SHELAIRE DR UNIT 1
MANSFIELD OH
44903-9297
US

V. Phone/Fax

Practice location:
  • Phone: 419-468-4220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberAPRN.CNP.023617
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: