=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730715822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZETTE JONES NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2020
-----------------------------------------------------
Last Update Date | 03/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MID-STATE OCCUPATIONAL HEALTH SERVICES, INC. 1000 MEADE STREET
-----------------------------------------------------
City | DUNMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-209-7160
-----------------------------------------------------
Fax | 570-209-7164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MID-STATE OCCUPATIONAL HEALTH SERVICES, INC. 1000 MEADE STREET
-----------------------------------------------------
City | DUNMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-209-7160
-----------------------------------------------------
Fax | 570-209-7164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | SP021335
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------