Provider Demographics
NPI:1972081479
Name:JASON, NYARADZAI BIANCA (LPN)
Entity type:Individual
Prefix:
First Name:NYARADZAI
Middle Name:BIANCA
Last Name:JASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NYARADZAI
Other - Middle Name:BIANCA
Other - Last Name:JASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5552 LITTLE FLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6808
Mailing Address - Country:US
Mailing Address - Phone:513-919-9956
Mailing Address - Fax:
Practice Address - Street 1:5552 LITTLE FLOWER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6808
Practice Address - Country:US
Practice Address - Phone:513-919-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126094IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse