Provider Demographics
NPI:1164202529
Name:BOHRER, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BOHRER
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 1:947 BONANZA LN
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9986
Mailing Address - Country:US
Mailing Address - Phone:609-319-8069
Mailing Address - Fax:
Practice Address - Street 1:947 BONANZA LN
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9986
Practice Address - Country:US
Practice Address - Phone:609-319-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCT4F53XWI163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool