Provider Demographics
NPI:1831857093
Name:JONES, STEPHANIE DENISE (ADN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 EASTBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5201
Mailing Address - Country:US
Mailing Address - Phone:585-456-7654
Mailing Address - Fax:
Practice Address - Street 1:439 EASTBROOKE LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5201
Practice Address - Country:US
Practice Address - Phone:585-456-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY826517163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse