MEDICARE: JAMIE JONES CNP

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	CNP3630	MN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3630	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	411952112	OTHER	MN	TAX ID

General Provider Information

NPI Number	:	1548651409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE JONES CNP

Provider Business Mailing Address
First Line	:	30 1ST AVE NE STE 7
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-1515
Country	:	US
Telephone Number	:	763-400-8177
Fax Number	:	304-301-3047

Provider Business Practice Location Address
First Line	:	30 1ST AVE NE STE 7
Second Line	:
City	:	BUFFALO
State	:	MN
Zip	:	55313-1515
Country	:	US
Telephone Number	:	763-400-8177
Fax Number	:	304-301-3047

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

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	08/12/2024

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