Provider Demographics
NPI:1184824435
Name:JONES, BRANDON WAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:WAYNE
Last Name:JONES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 N TENAYA WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0456
Mailing Address - Country:US
Mailing Address - Phone:702-388-8996
Mailing Address - Fax:702-387-8763
Practice Address - Street 1:2931 N TENAYA WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0456
Practice Address - Country:US
Practice Address - Phone:702-388-8996
Practice Address - Fax:702-387-8763
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN146801367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ326705Medicaid
AZZ121671Medicare PIN