Healthcare Provider Details

I. General information

NPI: 1659039048
Provider Name (Legal Business Name): ANN R JONES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 FOREST DR
COUNCIL BLUFFS IA
51503-4704
US

IV. Provider business mailing address

535 FOREST DR
COUNCIL BLUFFS IA
51503-4704
US

V. Phone/Fax

Practice location:
  • Phone: 402-658-8765
  • Fax:
Mailing address:
  • Phone: 402-658-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101512
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number101512
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: