Provider Demographics
NPI:1508051699
Name:JONES, LILLIAN M (RN)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
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:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:TOHATCHI
Mailing Address - State:NM
Mailing Address - Zip Code:87325-0142
Mailing Address - Country:US
Mailing Address - Phone:505-733-8100
Mailing Address - Fax:505-733-8491
Practice Address - Street 1:07 CHOOSGHI DRIVE
Practice Address - Street 2:
Practice Address - City:TOHATCHI
Practice Address - State:NM
Practice Address - Zip Code:87325-0142
Practice Address - Country:US
Practice Address - Phone:505-733-8100
Practice Address - Fax:505-733-8491
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR35795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse