Provider Demographics
NPI:1124738323
Name:JONES, MARLIN ANDRE
Entity type:Individual
Prefix:MR
First Name:MARLIN
Middle Name:ANDRE
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 ORCHARD CT SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3274
Mailing Address - Country:US
Mailing Address - Phone:330-246-0822
Mailing Address - Fax:
Practice Address - Street 1:3414 ORCHARD CT SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3274
Practice Address - Country:US
Practice Address - Phone:330-246-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.105419.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse