Provider Demographics
NPI:1639147309
Name:VIRDEN, JOANN (PA)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:VIRDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 DELAWARE AVE
Mailing Address - Street 2:SUITE 205B
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-1400
Mailing Address - Country:US
Mailing Address - Phone:740-387-4578
Mailing Address - Fax:740-387-8638
Practice Address - Street 1:1069 DELAWARE AVE
Practice Address - Street 2:SUITE 205B
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1400
Practice Address - Country:US
Practice Address - Phone:740-387-4578
Practice Address - Fax:740-387-8638
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50000345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant