Provider Demographics
NPI:1942422720
Name:JONES, PAMELA KAY (BFA,MS,DOM,LAC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAY
Last Name:JONES
Suffix:
Gender:F
Credentials:BFA,MS,DOM,LAC
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 480105
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-8105
Mailing Address - Country:US
Mailing Address - Phone:763-767-0410
Mailing Address - Fax:
Practice Address - Street 1:12502 VAN BUREN ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3295
Practice Address - Country:US
Practice Address - Phone:763-767-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1050171100000X
NM424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist