Provider Demographics
NPI:1194440321
Name:JONES, IRENE MUTHONI
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MUTHONI
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 1:633 E RAY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4206
Mailing Address - Country:US
Mailing Address - Phone:480-812-3680
Mailing Address - Fax:
Practice Address - Street 1:633 E RAY RD STE 130
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4206
Practice Address - Country:US
Practice Address - Phone:480-812-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ156198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ156198Medicaid