Provider Demographics
NPI:1205041894
Name:JONES, SIDNE
Entity Type:Individual
Prefix:
First Name:SIDNE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 E. SOUTH TEMPLE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-355-1723
Mailing Address - Fax:801-355-1748
Practice Address - Street 1:508 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 206
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1013
Practice Address - Country:US
Practice Address - Phone:801-355-1723
Practice Address - Fax:801-355-1748
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2177864405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health