MEDICARE: SIERRA JONES

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1932625829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA JONES

Provider Business Mailing Address
First Line	:	51483 TOWNSHIP ROAD 159
Second Line	:
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-9509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51483 TOWNSHIP ROAD 159
Second Line	:
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-9509
Country	:	US
Telephone Number	:	740-545-9111
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	08/22/2017

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