Provider Demographics
NPI:1760457360
Name:JONES, ANGELIA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-8446
Mailing Address - Country:US
Mailing Address - Phone:513-836-7039
Mailing Address - Fax:
Practice Address - Street 1:241 5TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-8446
Practice Address - Country:US
Practice Address - Phone:513-836-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-088011164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2498800Medicare ID - Type Unspecified