Healthcare Provider Details

I. General information

NPI: 1831256825
Provider Name (Legal Business Name): MRS. SHANNON MARIE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 OAKINGTON ST
ABERDEEN PROVING GROUND MD
21005-5131
US

IV. Provider business mailing address

103 PLUMB POINT LOOP
ABERDEEN PROVING GROUND MD
21005-1405
US

V. Phone/Fax

Practice location:
  • Phone: 410-278-1899
  • Fax:
Mailing address:
  • Phone: 410-306-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: