Provider Demographics
NPI:1306274261
Name:RIEBEN, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RIEBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MOUNTIAN VIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:BELL BUCKLE
Mailing Address - State:TN
Mailing Address - Zip Code:37020
Mailing Address - Country:US
Mailing Address - Phone:615-962-4238
Mailing Address - Fax:
Practice Address - Street 1:101 MOUNTIAN VIEW
Practice Address - Street 2:
Practice Address - City:BELL BUCKLE
Practice Address - State:TN
Practice Address - Zip Code:37020
Practice Address - Country:US
Practice Address - Phone:615-962-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000073184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse