Provider Demographics
NPI:1386929289
Name:WHITE, JASON GLENN (LPN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:GLENN
Last Name:WHITE
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 1:59 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:PA
Mailing Address - Zip Code:16401-1214
Mailing Address - Country:US
Mailing Address - Phone:814-756-5616
Mailing Address - Fax:
Practice Address - Street 1:59 N WATER ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:PA
Practice Address - Zip Code:16401-1214
Practice Address - Country:US
Practice Address - Phone:814-756-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN283427164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse