Provider Demographics
NPI:1972195535
Name:ARDELEAN, JASON T (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:ARDELEAN
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N SHIAWASSEE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1632
Mailing Address - Country:US
Mailing Address - Phone:989-729-1600
Mailing Address - Fax:989-729-4070
Practice Address - Street 1:721 N SHIAWASSEE ST STE 202
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1632
Practice Address - Country:US
Practice Address - Phone:989-729-1600
Practice Address - Fax:989-729-4070
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307495363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1972195535Medicaid