Provider Demographics
NPI:1467696112
Name:JONES, ANTOINETTE AYESHA (LPN)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:AYESHA
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9760
Mailing Address - Country:US
Mailing Address - Phone:585-330-0225
Mailing Address - Fax:
Practice Address - Street 1:4647 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9760
Practice Address - Country:US
Practice Address - Phone:585-330-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-25
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292657-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse