Provider Demographics
NPI:1326500018
Name:JONES, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
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 1:3800 N EL MIRAGE DR APT 4712
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4067
Mailing Address - Country:US
Mailing Address - Phone:800-487-2422
Mailing Address - Fax:
Practice Address - Street 1:3800 N EL MIRAGE DR APT 4712
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4067
Practice Address - Country:US
Practice Address - Phone:800-487-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor