Provider Demographics
NPI:1851675656
Name:JONES, ETHEL M
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:M
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 1:1445 AMERICAN PACIFIC DR # 110-301
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7402
Mailing Address - Country:US
Mailing Address - Phone:702-774-4696
Mailing Address - Fax:
Practice Address - Street 1:1445 AMERICAN PACIFIC DR # 110-301
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7402
Practice Address - Country:US
Practice Address - Phone:702-774-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11940003269OtherSOZO FAMILY SERVICES INC