Provider Demographics
NPI:1669935797
Name:PASKER, JON PAUL SMITH I (LPN)
Entity type:Individual
Prefix:
First Name:JON PAUL
Middle Name:SMITH
Last Name:PASKER
Suffix:I
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 1:516 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1932
Mailing Address - Country:US
Mailing Address - Phone:419-206-4101
Mailing Address - Fax:
Practice Address - Street 1:516 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-1932
Practice Address - Country:US
Practice Address - Phone:419-206-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH096750164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse