Provider Demographics
NPI:1144820242
Name:MOWERY, JONATHAN MICHAEL (LVN)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:MOWERY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BEECH ST APT 116
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-2760
Mailing Address - Country:US
Mailing Address - Phone:210-990-0216
Mailing Address - Fax:
Practice Address - Street 1:400 N BEECH ST APT 116
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-2760
Practice Address - Country:US
Practice Address - Phone:210-990-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338819164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse