MEDICARE: SIDNE JONES

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	363LW0102X	Women's Health Nurse Practitioner	2177864405	UT

General Provider Information

NPI Number	:	1205041894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNE JONES

Provider Business Mailing Address
First Line	:	508 E. SOUTH TEMPLE
Second Line	:	SUITE 206
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102
Country	:	US
Telephone Number	:	801-355-1723
Fax Number	:	801-355-1748

Provider Business Practice Location Address
First Line	:	508 E SOUTH TEMPLE
Second Line	:	SUITE 206
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1013
Country	:	US
Telephone Number	:	801-355-1723
Fax Number	:	801-355-1748

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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Directions to “ SIDNE JONES ” Practice Location

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