MEDICARE: MS. STACY EVE JONES LPN

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	164X00000X	Licensed Vocational Nurse	295092-1	NY

General Provider Information

NPI Number	:	1194267799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY EVE JONES LPN

Provider Business Mailing Address
First Line	:	4118 MCGRAW NORTH RD
Second Line	:
City	:	MC GRAW
State	:	NY
Zip	:	13101-9542
Country	:	US
Telephone Number	:	607-423-9245
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 MCGRAW NORTH RD
Second Line	:
City	:	MC GRAW
State	:	NY
Zip	:	13101-9542
Country	:	US
Telephone Number	:	607-423-9245
Fax Number	:

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

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/14/2016

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