Provider Demographics
NPI:1861779902
Name:JONES, CAROLYNE DENISE
Entity type:Individual
Prefix:MS
First Name:CAROLYNE
Middle Name:DENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUHIR
Other - Middle Name:BLACKEAGLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CC
Mailing Address - Street 1:4224 ARCATA WAY, SUITE A
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3381
Mailing Address - Country:US
Mailing Address - Phone:702-633-5525
Mailing Address - Fax:702-216-2923
Practice Address - Street 1:4224 ARCATA WAY, SUITE A
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3381
Practice Address - Country:US
Practice Address - Phone:702-633-5525
Practice Address - Fax:702-216-2923
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist