Healthcare Provider Details

I. General information

NPI: 1144531971
Provider Name (Legal Business Name): JAMES WILLIAM HAISLOP JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 MERRITT RD
THURMAN OH
45685-9349
US

IV. Provider business mailing address

591 MERRITT RD
THURMAN OH
45685-9349
US

V. Phone/Fax

Practice location:
  • Phone: 740-245-5563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.346909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: