Provider Demographics
NPI:1366675464
Name:JONES, BRECKEN F (RN)
Entity Type:Individual
Prefix:
First Name:BRECKEN
Middle Name:F
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 PETERS RD
Mailing Address - Street 2:
Mailing Address - City:CANASERAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14822-9744
Mailing Address - Country:US
Mailing Address - Phone:607-545-6577
Mailing Address - Fax:
Practice Address - Street 1:10475 COUNTY RT 24
Practice Address - Street 2:
Practice Address - City:SWAIN
Practice Address - State:NY
Practice Address - Zip Code:14884-0000
Practice Address - Country:US
Practice Address - Phone:607-545-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609664-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse