Provider Demographics
NPI:1245700707
Name:JONES RIVERA, MARIA EVELYN (LPN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:EVELYN
Last Name:JONES RIVERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:10545 OLD EAGLE RIVER RD APT 11
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8094
Mailing Address - Country:US
Mailing Address - Phone:907-390-0688
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN STE 160
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2561
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK123313164W00000X
AK147404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse