MEDICARE: PATRICIA LYNN JONES CN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	NU61157949	WA
2	133N00000X	Nutritionist	NU61157949	WA

General Provider Information

NPI Number	:	1114677911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LYNN JONES CN

Provider Business Mailing Address
First Line	:	1816 CHANNEL RD E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-9431
Country	:	US
Telephone Number	:	951-317-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 CHANNEL RD E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-9431
Country	:	US
Telephone Number	:	951-317-8721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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