Provider Demographics
NPI:1871842526
Name:JONES, STEPHANIE MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15516 SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8490
Mailing Address - Country:US
Mailing Address - Phone:402-706-2962
Mailing Address - Fax:
Practice Address - Street 1:15516 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8490
Practice Address - Country:US
Practice Address - Phone:402-706-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE938314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility