Provider Demographics
NPI:1235648460
Name:JONES, MARLENE FAYETTE (BSN)
Entity type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:FAYETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 N GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4410
Mailing Address - Country:US
Mailing Address - Phone:1336-723-3846
Mailing Address - Fax:
Practice Address - Street 1:2919 N GLENN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-4410
Practice Address - Country:US
Practice Address - Phone:1336-723-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care