Provider Demographics
NPI:1649776840
Name:COUSAR, JONATHAN (RN,BSN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:COUSAR
Suffix:
Gender:M
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 HERLONG CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1193
Mailing Address - Country:US
Mailing Address - Phone:803-323-6383
Mailing Address - Fax:803-328-2860
Practice Address - Street 1:1668 HERLONG CT
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1193
Practice Address - Country:US
Practice Address - Phone:803-323-6383
Practice Address - Fax:803-328-2860
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC203834163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)