Provider Demographics
NPI:1518255884
Name:CORLON, JONATHAN TAINGAY (LPN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TAINGAY
Last Name:CORLON
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 1:8 SOUTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1112
Mailing Address - Country:US
Mailing Address - Phone:610-809-7592
Mailing Address - Fax:
Practice Address - Street 1:8 SOUTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1112
Practice Address - Country:US
Practice Address - Phone:610-809-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN276640164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse