Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 16123 | OH |
N | 363LG0600X | Nurse Practitioner - Gerontology | 16123 | OH |
N | 363LP2300X | Nurse Practitioner - Primary Care | 16123 | OH |
NPI | 1023406394 |
---|---|
Provider Name | Jason Sindledecker |
First Address | Youngstown, OH 44512-4226 |
Second Address | Youngstown, OH 44512-4226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2015 |
Last Update Date | 23/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0118087 | (05) | OH |