Healthcare Provider Details

I. General information

NPI: 1336402726
Provider Name (Legal Business Name): LANNETTA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 S MARYLAND PKWY STE 310
LAS VEGAS NV
89109-1566
US

IV. Provider business mailing address

2125 N LAS VEGAS BLVD APT 1036
N LAS VEGAS NV
89030-5888
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-3800
  • Fax: 702-240-3001
Mailing address:
  • Phone: 702-610-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: