MEDICARE: MARY K JONES REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.289730	OH

General Provider Information

NPI Number	:	1134890460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY K JONES REGISTERED NURSE

Provider Business Mailing Address
First Line	:	7770 COLUMBUS RD NE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9773
Country	:	US
Telephone Number	:	330-875-1456
Fax Number	:	330-875-1576

Provider Business Practice Location Address
First Line	:	7770 COLUMBUS RD NE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9773
Country	:	US
Telephone Number	:	330-875-1456
Fax Number	:	330-875-1576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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