Individual
MR. JONATHAN ERIC JUSKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, PA-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28154059A
IN
363AS0400X
Surgical Physician Assistant
Primary
085002855
IL
363AS0400X
Surgical Physician Assistant
10000984A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01618941
BLUECROSS/BLUESHIELD
IL
Enumeration date
11/08/2006
Last updated
03/10/2015
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