MEDICARE: ILAH R JONES CNP

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	363L00000X	Nurse Practitioner	R21451	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1588646939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILAH R JONES CNP

Provider Business Mailing Address
First Line	:	2001 CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4592
Country	:	US
Telephone Number	:	505-281-3406
Fax Number	:	505-873-7444

Provider Business Practice Location Address
First Line	:	2001 CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4592
Country	:	US
Telephone Number	:	505-873-7462
Fax Number	:	505-873-7444

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/18/2011

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