Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | RN041390 | AZ |
NPI | 1023017811 |
---|---|
Provider Name | Michele R Jones |
First Address | Prescott, AZ 86305-1433 |
Second Address | Prescott, AZ 86305-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
837528 | (05) | AZ |
R74885 | (02) | |
WMBGN | RRM (01) |