Provider Demographics
NPI:1538467709
Name:JONES, MATTHEW A (LPN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2322
Mailing Address - Country:US
Mailing Address - Phone:585-474-7581
Mailing Address - Fax:585-529-4551
Practice Address - Street 1:42 MERRILL ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2322
Practice Address - Country:US
Practice Address - Phone:585-474-7581
Practice Address - Fax:585-529-4551
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278069164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse