Provider Demographics
NPI:1043429160
Name:JONES, DENISE MARIE (RN,BSN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:EBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3495 E NORTHBROOK CT
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4767
Mailing Address - Country:US
Mailing Address - Phone:414-762-9563
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-646-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI110639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV38313700Medicaid