Basic Information
| Provider Information | |||||||||
| NPI: | 1801301601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | JARED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 632 N SHIAWASSEE ST | ||||||||
| Address2: | |||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488672232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897230330 | ||||||||
| FaxNumber: | 9897230327 | ||||||||
| Practice Location | |||||||||
| Address1: | 632 N SHIAWASSEE ST | ||||||||
| Address2: | |||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488672232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897230330 | ||||||||
| FaxNumber: | 9897230327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2017 | ||||||||
| LastUpdateDate: | 12/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | Y | Nursing Service Related Providers | Technician |
No ID Information.