Provider Demographics
NPI:1891326922
Name:JONES, VIVIAN MICHELLE
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:MICHELLE
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 1:920 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2453
Mailing Address - Country:US
Mailing Address - Phone:314-327-3631
Mailing Address - Fax:
Practice Address - Street 1:4618 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2424
Practice Address - Country:US
Practice Address - Phone:314-327-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health