Provider Demographics
NPI:1487006581
Name:GBAPAYWHEA JR, JONATHAN JANJAY (LPN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JANJAY
Last Name:GBAPAYWHEA JR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OFFICE CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3234
Mailing Address - Country:US
Mailing Address - Phone:267-513-1995
Mailing Address - Fax:
Practice Address - Street 1:500 OFFICE CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3234
Practice Address - Country:US
Practice Address - Phone:267-513-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN291887164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse