Provider Demographics
NPI:1659146074
Name:JONES, ELISABETH MANET
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MANET
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 1:1736 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3240
Mailing Address - Country:US
Mailing Address - Phone:401-743-0186
Mailing Address - Fax:
Practice Address - Street 1:3122 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7255
Practice Address - Country:US
Practice Address - Phone:907-357-1113
Practice Address - Fax:907-357-9593
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK137133163WN0002X
AK217148363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care