Provider Demographics
NPI:1851833503
Name:JORNYOUN, KLADE (RN)
Entity Type:Individual
Prefix:
First Name:KLADE
Middle Name:
Last Name:JORNYOUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 W WYANDOTTE RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1335
Mailing Address - Country:US
Mailing Address - Phone:419-350-1913
Mailing Address - Fax:
Practice Address - Street 1:3350 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1173
Practice Address - Country:US
Practice Address - Phone:419-255-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.486458163W00000X
OHPN.123119164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse