Provider Demographics
NPI:1427054816
Name:JONES, MICHAEL EVAN (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EVAN
Last Name:JONES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911244
Mailing Address - Street 2:ATTN: SMC ANESTHESIA
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1244
Mailing Address - Country:US
Mailing Address - Phone:719-557-4221
Mailing Address - Fax:719-557-3834
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:719-557-4221
Practice Address - Fax:719-557-3834
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33108269Medicaid
COC808640Medicare Oscar/Certification
184828Medicare ID - Type Unspecified
P28747Medicare UPIN