Provider Demographics
NPI:1528385853
Name:MARCUM, JOHNATHAN PAUL (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:PAUL
Last Name:MARCUM
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 1:18224 MARCUM LANE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:IN
Mailing Address - Zip Code:47024
Mailing Address - Country:US
Mailing Address - Phone:513-315-7332
Mailing Address - Fax:
Practice Address - Street 1:18224 MARCUM LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:IN
Practice Address - Zip Code:47024-8304
Practice Address - Country:US
Practice Address - Phone:513-315-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse