Provider Demographics
NPI:1083675540
Name:JONES, MARIE A (RD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:STOCKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0852
Mailing Address - Country:US
Mailing Address - Phone:530-244-5115
Mailing Address - Fax:
Practice Address - Street 1:1100 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0852
Practice Address - Country:US
Practice Address - Phone:530-244-5115
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28477ZMedicare ID - Type Unspecified