MEDICARE: JOAN 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	163W00000X	Registered Nurse	201608599RN	OR

General Provider Information

NPI Number	:	1366938227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN JONES

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VIRGINIA AVE STE 100
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-3477
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:

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

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	07/03/2018

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Directions to “ JOAN JONES ” Practice Location

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