Provider Demographics
NPI:1023017811
Name:JONES, MICHELE R (RNFA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 12TH PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1433
Mailing Address - Country:US
Mailing Address - Phone:928-778-4300
Mailing Address - Fax:928-771-0920
Practice Address - Street 1:919 12TH PL
Practice Address - Street 2:SUITE 1
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1433
Practice Address - Country:US
Practice Address - Phone:928-778-4300
Practice Address - Fax:928-771-0920
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN041390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ837528Medicaid
WMBGNOtherRRM
WMBGNOtherRRM
70345Medicare ID - Type Unspecified