Healthcare Provider Details

I. General information

NPI: 1134890460
Provider Name (Legal Business Name): MARY K JONES REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 COLUMBUS RD NE
LOUISVILLE OH
44641-9773
US

IV. Provider business mailing address

7770 COLUMBUS RD NE
LOUISVILLE OH
44641-9773
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-1456
  • Fax: 330-875-1576
Mailing address:
  • Phone: 330-875-1456
  • Fax: 330-875-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.289730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: