Provider Demographics
NPI:1710201447
Name:JONES, MARVELLA JUNE
Entity Type:Individual
Prefix:
First Name:MARVELLA
Middle Name:JUNE
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 1:3744 TEAYS VALLEY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8755
Mailing Address - Country:US
Mailing Address - Phone:304-757-6537
Mailing Address - Fax:304-757-6538
Practice Address - Street 1:3744 TEAYS VALLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8755
Practice Address - Country:US
Practice Address - Phone:304-757-6537
Practice Address - Fax:304-757-6538
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22333708163WH0200X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No376J00000XNursing Service Related ProvidersHomemaker