Provider Demographics
NPI:1538706692
Name:JONES, MARISSA ALEXCIA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ALEXCIA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 RYAN RD APT 21
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2073
Mailing Address - Country:US
Mailing Address - Phone:419-508-1822
Mailing Address - Fax:
Practice Address - Street 1:5123 RYAN RD APT 21
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2073
Practice Address - Country:US
Practice Address - Phone:419-508-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320950710914376K00000X
OHLPN.183673.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide