Basic Information
| Provider Information | |||||||||
| NPI: | 1689899767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | JOANN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 WESTGATE DRIVE | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121500 | ||||||||
| FaxNumber: | 6513121593 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 24TH AVE S | ||||||||
| Address2: | SUITE 515 | ||||||||
| City: | MPLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512257830 | ||||||||
| FaxNumber: | 6512257989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R1247888 | MN | Y | Nursing Service Providers | Registered Nurse |
No ID Information.