Provider Demographics
NPI:1699549386
Name:JONES, REBECCA EVELYN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:EVELYN
Last Name:JONES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
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 512
Mailing Address - Street 2:
Mailing Address - City:LAKE NEBAGAMON
Mailing Address - State:WI
Mailing Address - Zip Code:54849-0512
Mailing Address - Country:US
Mailing Address - Phone:715-730-0524
Mailing Address - Fax:
Practice Address - Street 1:11595 E COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:LAKE NEBAGAMON
Practice Address - State:WI
Practice Address - Zip Code:54849-9272
Practice Address - Country:US
Practice Address - Phone:715-730-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111067-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse