=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639721905
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORA JONES APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2019
-----------------------------------------------------
Last Update Date | 12/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1029 S. TRIMBLE RD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-522-3341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1029 S TRIMBLE RD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44906-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-522-3341
-----------------------------------------------------
Fax | 419-522-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.025151
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------