Provider Demographics
NPI:1851378434
Name:JONES, MARY C (PA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 STONE ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2660
Mailing Address - Country:US
Mailing Address - Phone:402-245-3232
Mailing Address - Fax:402-245-4022
Practice Address - Street 1:1423 STONE ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2660
Practice Address - Country:US
Practice Address - Phone:402-245-3232
Practice Address - Fax:402-245-4022
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275909Medicare ID - Type Unspecified
NEP66809Medicare UPIN