Provider Demographics
NPI:1750035671
Name:JONES, GINELLE STEVENS (FNP)
Entity Type:Individual
Prefix:
First Name:GINELLE
Middle Name:STEVENS
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-3484
Mailing Address - Country:US
Mailing Address - Phone:518-761-6580
Mailing Address - Fax:518-761-6422
Practice Address - Street 1:1340 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3484
Practice Address - Country:US
Practice Address - Phone:518-761-6580
Practice Address - Fax:518-761-6422
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY462543163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator