MEDICARE: MR. RUSSELL A. JONES FNP

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	363LF0000X	Family Nurse Practitioner	F333991-1	NY

General Provider Information

NPI Number	:	1457320483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL A. JONES FNP

Provider Business Mailing Address
First Line	:	102 RAND HILL RD
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-3209
Country	:	US
Telephone Number	:	518-314-6849
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 PLAZA BLVD STE 102
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6438
Country	:	US
Telephone Number	:	518-324-7246
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	11/11/2007

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