Provider Demographics
NPI:1700814779
Name:JONES, DONNA R (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
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 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5637
Mailing Address - Fax:818-837-5589
Practice Address - Street 1:26357 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4488
Practice Address - Country:US
Practice Address - Phone:661-222-2605
Practice Address - Fax:661-222-2694
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN208118364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-1683892OtherOTHER INSURANCE
CARHM08609FMedicaid
CARHM08608FMedicaid
CAZZT40394FMedicaid
CARHM18553HMedicaid
CAZZT40394FMedicaid
CARHM08609FMedicaid
CAAY983SMedicare PIN