MEDICARE: JONATHAN EDWARD JARRELL

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
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1912129669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN EDWARD JARRELL

Provider Business Mailing Address
First Line	:	2716 S 5TH ST
Second Line	:
City	:	IRONTON
State	:	OH
Zip	:	45638-2711
Country	:	US
Telephone Number	:	740-534-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 CHARLOTTE ST
Second Line	:
City	:	IRONTON
State	:	OH
Zip	:	45638-1146
Country	:	US
Telephone Number	:	740-533-0061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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