Provider Demographics
NPI:1194267799
Name:JONES, STACY EVE (LPN)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:EVE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 MCGRAW NORTH RD
Mailing Address - Street 2:
Mailing Address - City:MC GRAW
Mailing Address - State:NY
Mailing Address - Zip Code:13101-9542
Mailing Address - Country:US
Mailing Address - Phone:607-423-9245
Mailing Address - Fax:
Practice Address - Street 1:4118 MCGRAW NORTH RD
Practice Address - Street 2:
Practice Address - City:MC GRAW
Practice Address - State:NY
Practice Address - Zip Code:13101-9542
Practice Address - Country:US
Practice Address - Phone:607-423-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295092-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse