Provider Demographics
NPI:1649558107
Name:JONES, IVAN QUINTON (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:QUINTON
Last Name:JONES
Suffix:
Gender:M
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 1:1509 SCHOFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-7453
Mailing Address - Country:US
Mailing Address - Phone:505-327-7616
Mailing Address - Fax:505-327-1413
Practice Address - Street 1:8335 OLD AZTEC HWY
Practice Address - Street 2:
Practice Address - City:FLORA VISTA
Practice Address - State:NM
Practice Address - Zip Code:87415-9639
Practice Address - Country:US
Practice Address - Phone:435-220-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN167319163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse