1710480405 NPI number — MRS. MANDI ELIZABETH JONES LPN

Table of content: MRS. MANDI ELIZABETH JONES LPN (NPI 1710480405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710480405 NPI number — MRS. MANDI ELIZABETH JONES LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
MANDI
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HIGGINS
Provider Other First Name:
MANDI
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710480405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1914 MERCER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARRELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16121-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-981-9815
Provider Business Mailing Address Fax Number:
724-981-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1914 MERCER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARRELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16121-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-981-9815
Provider Business Practice Location Address Fax Number:
724-981-2293
Provider Enumeration Date:
03/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN273150 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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