Provider Demographics
NPI:1326584244
Name:PRICKEL, JONAH HARRISON
Entity Type:Individual
Prefix:MR
First Name:JONAH
Middle Name:HARRISON
Last Name:PRICKEL
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 1:713 S BRIGHTON CRST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8684
Mailing Address - Country:US
Mailing Address - Phone:812-345-9697
Mailing Address - Fax:
Practice Address - Street 1:713 S BRIGHTON CRST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8684
Practice Address - Country:US
Practice Address - Phone:812-345-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program