Provider Demographics
NPI:1306166194
Name:SPIERS, JASON DOUGLAS (LPN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DOUGLAS
Last Name:SPIERS
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 1:3096 CHARLOTTE MILL DR
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45418-2952
Mailing Address - Country:US
Mailing Address - Phone:937-830-4800
Mailing Address - Fax:
Practice Address - Street 1:3096 CHARLOTTE MILL DR
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45418-2952
Practice Address - Country:US
Practice Address - Phone:937-830-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0116973146M00000X
OHPN129661164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate