MEDICARE: LATONYA WENDY HIXONADAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	4704278241	MI

General Provider Information

NPI Number	:	1184507642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA WENDY HIXONADAMS

Provider Business Mailing Address
First Line	:	30200 TELEGRAPH RD STE 300
Second Line	:
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-4503
Country	:	US
Telephone Number	:	248-451-3759
Fax Number	:

Provider Business Practice Location Address
First Line	:	3695 PINOAK ST
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-1380
Country	:	US
Telephone Number	:	313-685-4292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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