Basic Information
| Provider Information | |||||||||
| NPI: | 1952957631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDYNE | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7527 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430170727 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 921 E FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | KENTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433262020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145668883 | ||||||||
| FaxNumber: | 6145668149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2019 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.024658 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.