Provider Demographics
NPI:1811249626
Name:ASHBURN, JASON RICHARD (LPN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:RICHARD
Last Name:ASHBURN
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 1:1299 CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-9712
Mailing Address - Country:US
Mailing Address - Phone:937-279-7848
Mailing Address - Fax:
Practice Address - Street 1:1299 CRAWFORD RD
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9712
Practice Address - Country:US
Practice Address - Phone:937-279-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.120705-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse