Provider Demographics
NPI:1831654276
Name:JONES, SHELLY MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 EVANSTON CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-1137
Mailing Address - Country:US
Mailing Address - Phone:419-309-8573
Mailing Address - Fax:
Practice Address - Street 1:3311 EVANSTON CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1137
Practice Address - Country:US
Practice Address - Phone:419-309-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168917164W00000X
OH526020163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse