Provider Demographics
NPI:1699900886
Name:NEBEL, JON DAVID (R PH)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:DAVID
Last Name:NEBEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E M35
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-9159
Mailing Address - Country:US
Mailing Address - Phone:906-346-0104
Mailing Address - Fax:906-346-6422
Practice Address - Street 1:130 E M35
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-9159
Practice Address - Country:US
Practice Address - Phone:906-346-0104
Practice Address - Fax:906-346-6422
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302025133OtherPHARMACIST LICENSE