Provider Demographics
NPI:1225174394
Name:ELY, JONA M (NP)
Entity Type:Individual
Prefix:MS
First Name:JONA
Middle Name:M
Last Name:ELY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JONA
Other - Middle Name:M
Other - Last Name:KOHPAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1435
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81626-1435
Mailing Address - Country:US
Mailing Address - Phone:970-826-0911
Mailing Address - Fax:970-826-0910
Practice Address - Street 1:595 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1920
Practice Address - Country:US
Practice Address - Phone:970-826-0911
Practice Address - Fax:970-826-0910
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101247363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner