Provider Demographics
NPI:1154882413
Name:JONES, MARSHA LYNN
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4037
Mailing Address - Country:US
Mailing Address - Phone:262-902-4147
Mailing Address - Fax:
Practice Address - Street 1:1700 WEST LAWN AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-3878
Practice Address - Country:US
Practice Address - Phone:262-583-1660
Practice Address - Fax:262-770-3150
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health