=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922817436
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVETTE RENEE JONES LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2024
-----------------------------------------------------
Last Update Date | 12/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 BAILEY AVE STE 2
-----------------------------------------------------
City | NEEDLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92363-3105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-326-9313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11995 PEPPERWOOD ST
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92392-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-561-2278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | 193114
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------