=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033690805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON ROBERT DAY CRNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2018
-----------------------------------------------------
Last Update Date | 12/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4111 LOWER BECKLEYSVILLE RD
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21074-2248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-374-0808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2842 SCARFF RD
-----------------------------------------------------
City | FALLSTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21047-1317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-615-6554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R213343
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------