Provider Demographics
NPI:1730465238
Name:WILFEARD, JON (LPN)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:WILFEARD
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 1:678 COUNTY ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-4130
Mailing Address - Country:US
Mailing Address - Phone:607-547-7447
Mailing Address - Fax:
Practice Address - Street 1:678 COUNTY ROUTE 59
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-4130
Practice Address - Country:US
Practice Address - Phone:607-547-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299159-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse