Provider Demographics
NPI:1093569972
Name:FREDERICK, JONATHAN CHANDLER (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHANDLER
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5611
Mailing Address - Country:US
Mailing Address - Phone:419-707-2525
Mailing Address - Fax:
Practice Address - Street 1:509 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5611
Practice Address - Country:US
Practice Address - Phone:419-707-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.473414163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse