Provider Demographics
NPI:1922875145
Name:EASLEY, JONATHAN STEREN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:STEREN
Last Name:EASLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4664 PENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1104
Mailing Address - Country:US
Mailing Address - Phone:419-450-4661
Mailing Address - Fax:
Practice Address - Street 1:4664 PENRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1104
Practice Address - Country:US
Practice Address - Phone:419-450-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver