Provider Demographics
NPI:1598057051
Name:VINSON, JASON GUY (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:GUY
Last Name:VINSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 FOXHAVEN CHASE
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-3800
Mailing Address - Country:US
Mailing Address - Phone:262-752-7364
Mailing Address - Fax:
Practice Address - Street 1:8400 FOXHAVEN CHASE
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-3800
Practice Address - Country:US
Practice Address - Phone:262-752-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156186-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health