Provider Demographics
NPI:1518113364
Name:JONES, HEATHER SUZZANNE (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUZZANNE
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 1:1448 CALDWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:NY
Mailing Address - Zip Code:13797-1617
Mailing Address - Country:US
Mailing Address - Phone:607-213-4007
Mailing Address - Fax:
Practice Address - Street 1:1448 CALDWELL HILL RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:NY
Practice Address - Zip Code:13797-1617
Practice Address - Country:US
Practice Address - Phone:607-213-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271366164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse