Provider Demographics
NPI:1891967337
Name:PRIMUS, JONNA R (CRNFA)
Entity Type:Individual
Prefix:MS
First Name:JONNA
Middle Name:R
Last Name:PRIMUS
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-0316
Mailing Address - Country:US
Mailing Address - Phone:812-882-6637
Mailing Address - Fax:812-886-8938
Practice Address - Street 1:2121 WILLOW ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5355
Practice Address - Country:US
Practice Address - Phone:812-882-6637
Practice Address - Fax:812-886-8938
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28103706A163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant