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General NPI Number Information
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NPI Number | 1386120111
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Entity Type | Individual
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Provider Name | JARED IRELAND DEBOARD RN
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Gender | Male
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 2720 JENNINGS RD
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City | NEW LONDON
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State | OH
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Zip | 44851-9375
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Country | US
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Telephone | 419-677-6081
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 JENNINGS RD
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City | NEW LONDON
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State | OH
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Zip | 44851-9375
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Country | US
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Telephone | 440-557-7400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | RN429821
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License Number State | OH
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