Basic Information
Provider Information
NPI: 1033556139
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: ANDREANA
MiddleName: ROCHELLE
NamePrefix:  
NameSuffix:  
Credential: RN BSN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3415 SE POWELL BLVD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972023371
CountryCode: US
TelephoneNumber: 5032349591
FaxNumber: 5032053554
Practice Location
Address1: 3415 SE POWELL BLVD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972023371
CountryCode: US
TelephoneNumber: 5032349591
FaxNumber: 5032053554
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 05/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0807X201243583RNORY Nursing Service ProvidersRegistered NursePsych/Mental Health, Child & Adolescent

No ID Information.


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