Provider Demographics
NPI:1598371601
Name:LEVAN, JONNA JO
Entity Type:Individual
Prefix:MRS
First Name:JONNA
Middle Name:JO
Last Name:LEVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 COUNTY ROAD 55
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9225
Mailing Address - Country:US
Mailing Address - Phone:937-597-2547
Mailing Address - Fax:
Practice Address - Street 1:4024 COUNTY ROAD 55
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9225
Practice Address - Country:US
Practice Address - Phone:937-597-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0338661Medicaid