Provider Demographics
NPI:1477317238
Name:DEWHURST, JAY A
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:DEWHURST
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 1:132 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45775-8000
Mailing Address - Country:US
Mailing Address - Phone:304-881-9674
Mailing Address - Fax:
Practice Address - Street 1:132 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:OH
Practice Address - Zip Code:45775-8000
Practice Address - Country:US
Practice Address - Phone:304-881-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide