Basic Information
| Provider Information | |||||||||
| NPI: | 1639147309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIRDEN | ||||||||
| FirstName: | JOANN | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1069 DELAWARE AVE | ||||||||
| Address2: | SUITE 205B | ||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433021400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403874578 | ||||||||
| FaxNumber: | 7403878638 | ||||||||
| Practice Location | |||||||||
| Address1: | 1069 DELAWARE AVE | ||||||||
| Address2: | SUITE 205B | ||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433021400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403874578 | ||||||||
| FaxNumber: | 7403878638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50000345 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.