Provider Demographics
NPI:1043653546
Name:JONES, RENEE SHANTEL (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:SHANTEL
Last Name:JONES
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 RICHARD SHAW RD
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8625
Mailing Address - Country:US
Mailing Address - Phone:252-435-6055
Mailing Address - Fax:757-455-8055
Practice Address - Street 1:205 BUSINESS PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6535
Practice Address - Country:US
Practice Address - Phone:757-422-5502
Practice Address - Fax:757-455-8055
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI210378163W00000X
VA10926412163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant