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General NPI Number Information
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NPI Number | 1649558107
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Entity Type | Individual
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Provider Name | IVAN QUINTON JONES REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 8335 OLD AZTEC HWY
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City | FLORA VISTA
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State | NM
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Zip | 87415-9639
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Country | US
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Telephone | 435-220-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 SCHOFIELD LN
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City | FARMINGTON
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State | NM
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Zip | 87401-7453
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Country | US
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Telephone | 505-327-7616
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Fax | 505-327-1413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN167319
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License Number State | AZ
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