Provider Demographics
NPI:1952631210
Name:HARTLEY, JONATHAN R (LPN)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:R
Last Name:HARTLEY
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 1:220 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:POWHATAN POINT
Mailing Address - State:OH
Mailing Address - Zip Code:43942-1346
Mailing Address - Country:US
Mailing Address - Phone:740-795-5825
Mailing Address - Fax:
Practice Address - Street 1:220 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:POWHATAN POINT
Practice Address - State:OH
Practice Address - Zip Code:43942-1346
Practice Address - Country:US
Practice Address - Phone:740-795-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.130726-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse