Provider Demographics
NPI:1578594396
Name:JONES, BRENDA JOYCE (ADN/RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:JONES
Suffix:
Gender:F
Credentials:ADN/RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5052 SPANISH CANYON WAY APT D
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-2717
Mailing Address - Country:US
Mailing Address - Phone:760-386-2125
Mailing Address - Fax:
Practice Address - Street 1:INNER LOOP ROAD
Practice Address - Street 2:BLDG. 166
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5056
Practice Address - Country:US
Practice Address - Phone:760-380-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN121501163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control