Provider Demographics
NPI:1629586011
Name:JONES, CARRIE DEE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:DEE
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:PO BOX 7397
Mailing Address - Street 2:
Mailing Address - City:SHONTO
Mailing Address - State:AZ
Mailing Address - Zip Code:86054-7397
Mailing Address - Country:US
Mailing Address - Phone:928-672-3000
Mailing Address - Fax:928-672-3005
Practice Address - Street 1:HWY 98 & ROUTE 16
Practice Address - Street 2:
Practice Address - City:TONALEA
Practice Address - State:AZ
Practice Address - Zip Code:86044
Practice Address - Country:US
Practice Address - Phone:928-672-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25349064246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
25349064OtherASCP