Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71005759A | IN |
NPI | 1003290974 |
---|---|
Provider Name | Marilyn Ann Jones |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46227-7204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2015 |
Last Update Date | 16/03/2021 |