Provider Demographics
NPI:1922685858
Name:MERSEREAU, JONATHAN SCOTT (NP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:MERSEREAU
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:870 FRANKLIN RD APT G6
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-4110
Mailing Address - Country:US
Mailing Address - Phone:567-825-4723
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-1066
Practice Address - Country:US
Practice Address - Phone:567-825-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029281363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH427670OtherOHIO BOARD OF NURSING