Healthcare Provider Details

I. General information

NPI: 1811538671
Provider Name (Legal Business Name): MRS. CORINE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 141ST PL
BLUE ISLAND IL
60406-3311
US

IV. Provider business mailing address

5000 S 5TH AVE
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number043066005
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: