Provider Demographics
NPI:1639128028
Name:JONES, DANIEL THOMAS (MSFNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:THOMAS
Last Name:JONES
Suffix:
Gender:M
Credentials:MSFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9668
Mailing Address - Country:US
Mailing Address - Phone:503-982-2174
Mailing Address - Fax:503-982-4599
Practice Address - Street 1:1390 MERIDIAN DR
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9668
Practice Address - Country:US
Practice Address - Phone:503-982-2174
Practice Address - Fax:503-982-4599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079043456N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121710Medicaid
ORP25216Medicare UPIN
OR121710Medicaid