Provider Demographics
NPI:1073208203
Name:WETTIG, JASON DAVID (LVN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DAVID
Last Name:WETTIG
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 W COLONIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5006
Mailing Address - Country:US
Mailing Address - Phone:408-674-6215
Mailing Address - Fax:
Practice Address - Street 1:6199 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-6834
Practice Address - Country:US
Practice Address - Phone:916-726-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685799164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse