MEDICARE: MRS. URSULA TABITHA JONES FNP

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	4704270914	MI

General Provider Information

NPI Number	:	1659823847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. URSULA TABITHA JONES FNP

Provider Business Mailing Address
First Line	:	17312 FORRER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3538
Country	:	US
Telephone Number	:	313-330-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	17312 FORRER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3538
Country	:	US
Telephone Number	:	313-330-8066
Fax Number	:

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

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	11/04/2016

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