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NPI Code Detail

MEDICARE: MARY GWENDOLYN JONES PA-C

MEDICARE: MARY GWENDOLYN JONES PA-C
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
1363AM0700XMedical Physician AssistantPA10004952WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407879042
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY GWENDOLYN JONES PA-C
Provider Business Mailing Address
First Line : 2600 SW HOLDEN ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-3505
Country : US
Telephone Number : 206-300-3294
Fax Number :
Provider Business Practice Location Address
First Line : 2600 SW HOLDEN ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-3505
Country : US
Telephone Number : 206-300-3294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 07/30/2010

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Directions to “ MARY GWENDOLYN JONES PA-C” Practice Location

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