Provider Demographics
NPI:1407306186
Name:ALBERS, JOHNATHAN
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:ALBERS
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 1:17 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1247
Mailing Address - Country:US
Mailing Address - Phone:317-439-5610
Mailing Address - Fax:
Practice Address - Street 1:17 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1247
Practice Address - Country:US
Practice Address - Phone:317-439-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1276-6403146N00000X
2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer