Provider Demographics
NPI:1164083598
Name:JONES, JADA CHANTEL (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:CHANTEL
Last Name:JONES
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 COOKE ST UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-2302
Mailing Address - Country:US
Mailing Address - Phone:475-323-3059
Mailing Address - Fax:
Practice Address - Street 1:21 COOKE ST UNIT 2B
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2302
Practice Address - Country:US
Practice Address - Phone:475-323-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20-0351Y16246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy