Healthcare Provider Details

I. General information

NPI: 1134207624
Provider Name (Legal Business Name): IONIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LOVELL ST
IONIA MI
48846-9706
US

IV. Provider business mailing address

330 LOVELL ST
IONIA MI
48846-9706
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-5732
  • Fax: 616-527-5720
Mailing address:
  • Phone: 616-527-5732
  • Fax: 616-527-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHERYL HILDEBRANDT
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-527-5732