Provider Demographics
NPI:1649556028
Name:STONE, JADE ROXANNE (LVN)
Entity type:Individual
Prefix:MISS
First Name:JADE
Middle Name:ROXANNE
Last Name:STONE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 E 3RD ST
Mailing Address - Street 2:# 16
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3421
Mailing Address - Country:US
Mailing Address - Phone:562-786-0070
Mailing Address - Fax:
Practice Address - Street 1:1008 E 3RD ST
Practice Address - Street 2:# 16
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3421
Practice Address - Country:US
Practice Address - Phone:562-786-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190722164X00000X, 171M00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator