Provider Demographics
NPI:1417184292
Name:NUBAR, JAN (RN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:NUBAR
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 1:1031 STATE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1803
Mailing Address - Country:US
Mailing Address - Phone:814-455-7827
Mailing Address - Fax:814-455-7831
Practice Address - Street 1:1031 STATE ST
Practice Address - Street 2:SUITE D
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1803
Practice Address - Country:US
Practice Address - Phone:814-455-7827
Practice Address - Fax:814-455-7831
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN183661L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse