Provider Demographics
NPI:1427020775
Name:JONES, RENEE A (PA-C)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 DEERHAVEN LN NE APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-7302
Mailing Address - Country:US
Mailing Address - Phone:507-398-3859
Mailing Address - Fax:
Practice Address - Street 1:2199 HIGHWAY 36 E
Practice Address - Street 2:TARGET CLINIC
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2215
Practice Address - Country:US
Practice Address - Phone:651-779-5986
Practice Address - Fax:651-773-4170
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q36172Medicare UPIN
MNP00237068Medicare ID - Type UnspecifiedRAILROAD