Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036-109273 | IL |
Y | 208600000X | Surgeon | 036-109273 | IL |
NPI | 1003876939 |
---|---|
Provider Name | Anngell Jones |
First Address | E Stroudsburg, PA 18301-3006 |
Second Address | East Stroudsburg, PA 18301-8262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013552090001 | (05) | PA |
I40739 | (02) | PA |