Provider Demographics
NPI:1760267090
Name:JONES, VAUNDLE CHAUNETRA
Entity Type:Individual
Prefix:MRS
First Name:VAUNDLE
Middle Name:CHAUNETRA
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 1:44415 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1418
Mailing Address - Country:US
Mailing Address - Phone:586-690-5797
Mailing Address - Fax:
Practice Address - Street 1:44415 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1418
Practice Address - Country:US
Practice Address - Phone:586-690-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000056175390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program