Provider Demographics
NPI:1346479565
Name:PRIMA, JUSTINA JAYNE (RN)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:JAYNE
Last Name:PRIMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 COUNTY ROAD 775
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9725
Mailing Address - Country:US
Mailing Address - Phone:419-368-8354
Mailing Address - Fax:
Practice Address - Street 1:2280 COUNTY ROAD 775
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9725
Practice Address - Country:US
Practice Address - Phone:419-368-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH316335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse