Provider Demographics
NPI:1073002200
Name:JURKIEWICZ, JON
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:JURKIEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OAKWOOD DR STE 460
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1956
Mailing Address - Country:US
Mailing Address - Phone:336-793-0459
Mailing Address - Fax:
Practice Address - Street 1:110 OAKWOOD DR STE 460
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1956
Practice Address - Country:US
Practice Address - Phone:336-793-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1534237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist