Provider Demographics
NPI:1720843915
Name:WITHROW, JOHNATHAN CHANCE (RN-BSN)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:CHANCE
Last Name:WITHROW
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:MAXWELTON
Mailing Address - State:WV
Mailing Address - Zip Code:24957-8066
Mailing Address - Country:US
Mailing Address - Phone:304-497-2850
Mailing Address - Fax:877-276-8563
Practice Address - Street 1:414 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:MAXWELTON
Practice Address - State:WV
Practice Address - Zip Code:24957
Practice Address - Country:US
Practice Address - Phone:304-497-2850
Practice Address - Fax:877-276-8563
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV116567163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse