Provider Demographics
NPI:1386120111
Name:DEBOARD, JARED IRELAND (RN)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:IRELAND
Last Name:DEBOARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 JENNINGS RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9375
Mailing Address - Country:US
Mailing Address - Phone:440-557-7400
Mailing Address - Fax:
Practice Address - Street 1:2720 JENNINGS RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-9375
Practice Address - Country:US
Practice Address - Phone:419-677-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN429821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse