Individual
JANA L BOURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
495 S SHOOP AVE, WAUSEON, OH 43567-1719
(419) 335-7921
(419) 337-5988
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.089018
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2792456
—
OH
Enumeration date
05/15/2007
Last updated
02/08/2023
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