Provider Demographics
NPI:1568893394
Name:KASTEN, JASON HARLAND (LPN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:HARLAND
Last Name:KASTEN
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 1:21 SHAG BARK LN
Mailing Address - Street 2:
Mailing Address - City:PENNELLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13132-3138
Mailing Address - Country:US
Mailing Address - Phone:315-668-1901
Mailing Address - Fax:
Practice Address - Street 1:21 SHAG BARK LN
Practice Address - Street 2:
Practice Address - City:PENNELLVILLE
Practice Address - State:NY
Practice Address - Zip Code:13132-3138
Practice Address - Country:US
Practice Address - Phone:315-668-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse