Provider Demographics
NPI:1033290176
Name:JONES, SUSAN JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JEAN
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 STATE ROUTE 193
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44048-9725
Mailing Address - Country:US
Mailing Address - Phone:440-224-3085
Mailing Address - Fax:
Practice Address - Street 1:5131 BOUGHNER RD
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9756
Practice Address - Country:US
Practice Address - Phone:440-474-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109138164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284362OtherINDEPENDENT PROVIDER#