Provider Demographics
NPI:1376552877
Name:JONES, THERESA STEPHANINE (MS PA C)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:STEPHANINE
Last Name:JONES
Suffix:
Gender:F
Credentials:MS PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43650 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1120
Mailing Address - Country:US
Mailing Address - Phone:586-263-0820
Mailing Address - Fax:586-263-3819
Practice Address - Street 1:43650 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1120
Practice Address - Country:US
Practice Address - Phone:586-263-0820
Practice Address - Fax:586-263-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003971363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical