Provider Demographics
NPI:1295002673
Name:VIVIAN-JONES, EVA
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:VIVIAN-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 1:8112 S RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2735
Mailing Address - Country:US
Mailing Address - Phone:773-970-1801
Mailing Address - Fax:888-649-4611
Practice Address - Street 1:8112 S RICHMOND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-2735
Practice Address - Country:US
Practice Address - Phone:773-970-1801
Practice Address - Fax:888-649-4611
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1899264376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker