Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35048255 | OH |
NPI | 1124073283 |
---|---|
Provider Name | Edna Marie Jones |
First Address | Cincinnati, OH 45202-1459 |
Second Address | Marion, OH 43302-2331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0535102 | (05) | OH |
A15315 | (02) |