Provider Demographics
NPI:1770934036
Name:JONES, LUCY AS AYESHA (PUBLIC HEALTH NURSE)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:AS AYESHA
Last Name:JONES
Suffix:
Gender:F
Credentials:PUBLIC HEALTH NURSE
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:M
Other - Last Name:REYES ROBLEDO-PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2073 OLYMPIC STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-682-3550
Mailing Address - Fax:541-682-3551
Practice Address - Street 1:2411 MARTIN LUTHER KING LANE BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2237
Practice Address - Country:US
Practice Address - Phone:541-682-3608
Practice Address - Fax:541-682-3276
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407111RN163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201407111RNOtherREGISTERED NURSE