Provider Demographics
NPI:1225429905
Name:JONES, SHANITA DEANNA
Entity Type:Individual
Prefix:MS
First Name:SHANITA
Middle Name:DEANNA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHANITA
Other - Middle Name:DEANNA
Other - Last Name:SIGGERS-MIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15335 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2046
Mailing Address - Country:US
Mailing Address - Phone:313-283-0541
Mailing Address - Fax:
Practice Address - Street 1:15335 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2046
Practice Address - Country:US
Practice Address - Phone:313-283-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703113185164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse