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NPI Code Detail

MEDICARE: JONATHAN HOLBROOK RN

MEDICARE: JONATHAN HOLBROOK RN
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
1163W00000XRegistered Nurse1106819KY

General Provider Information

NPI Number : 1962290130
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN HOLBROOK RN
Provider Business Mailing Address
First Line : PO BOX 8209
Second Line :
City : VIENNA
State : VA
Zip : 22183-2058
Country : US
Telephone Number : 251-901-3011
Fax Number :
Provider Business Practice Location Address
First Line : 3499 BLAZER PKWY STE 330
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-2828
Country : US
Telephone Number : 251-901-3011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2025
Last Update Date : 04/28/2025

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