Provider Demographics
NPI:1508987819
Name:JONES, STACI JEAN (MSRDLD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:JEAN
Last Name:JONES
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1027
Mailing Address - Country:US
Mailing Address - Phone:641-343-7149
Mailing Address - Fax:
Practice Address - Street 1:304 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1027
Practice Address - Country:US
Practice Address - Phone:641-343-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered