Provider Demographics
NPI:1730325762
Name:JONES, SHANERICKA RESHONET (CRNA)
Entity type:Individual
Prefix:MISS
First Name:SHANERICKA
Middle Name:RESHONET
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CISSY
Other - Middle Name:RESHONET
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 37090
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3090
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-295-9369
Practice Address - Street 1:3998 FAIR RIDGE DRIVE
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2921
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN157231163W00000X
TN13884367500000X
VA0024171084367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00711618OtherRAILROAD MEDICARE
MS04870087Medicaid
TN1511595Medicaid
1730325762OtherCHAMPUS/HUMANA TRICARE
AR186289001Medicaid
TN4205212OtherBLUE CROSS
TN3600437Medicare PIN