Provider Demographics
NPI:1891060745
Name:JONES, GLORIA MAE (BA, MS,)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MAE
Last Name:JONES
Suffix:
Gender:F
Credentials:BA, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 NW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1215
Mailing Address - Country:US
Mailing Address - Phone:580-483-8089
Mailing Address - Fax:
Practice Address - Street 1:2327 NW 77TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-1215
Practice Address - Country:US
Practice Address - Phone:580-483-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-11
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor