Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP1015 | AZ |
NPI | 1083731558 |
---|---|
Provider Name | Lynda L Jones |
First Address | Chandler, AZ 85224-4226 |
Second Address | Chandler, AZ 85224-4226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MJ0815855 | DEA NUMBER (01) | AZ |
RN108898 | RN LICENSE NUMBER (01) | AZ |
S64122 | (02) |