Provider Demographics
NPI:1326352170
Name:MOON, JONI (LPN)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28180 OREGON RD LOT 836
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6511
Mailing Address - Country:US
Mailing Address - Phone:419-279-3512
Mailing Address - Fax:
Practice Address - Street 1:28180 OREGON RD LOT 836
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-6511
Practice Address - Country:US
Practice Address - Phone:419-279-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123666-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse