Healthcare Provider Details

I. General information

NPI: 1821195512
Provider Name (Legal Business Name): ARDELLA M JONES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLZ FL 8
NEW YORK NY
10119-0899
US

IV. Provider business mailing address

554 WARBURTON AVE
YONKERS NY
10701-1832
US

V. Phone/Fax

Practice location:
  • Phone: 917-576-4076
  • Fax:
Mailing address:
  • Phone: 914-965-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberMJ1144423
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304010
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: