Provider Demographics
NPI:1477308427
Name:BREHUN, JORDYN TAYLOR
Entity type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:TAYLOR
Last Name:BREHUN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16108 MASON RD
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-9211
Mailing Address - Country:US
Mailing Address - Phone:440-554-3758
Mailing Address - Fax:
Practice Address - Street 1:16108 MASON RD
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-9211
Practice Address - Country:US
Practice Address - Phone:440-554-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH50.009333RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program