Provider Demographics
NPI:1568009173
Name:JONES, ROSE M (LVN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N NORMA ST STE 133
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2577
Mailing Address - Country:US
Mailing Address - Phone:760-499-7406
Mailing Address - Fax:
Practice Address - Street 1:1400 N NORMA ST STE 133
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2577
Practice Address - Country:US
Practice Address - Phone:760-499-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696502164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse