Healthcare Provider Details

I. General information

NPI: 1790593952
Provider Name (Legal Business Name): KATIE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 MARKET ST
MACKINAC ISLAND MI
49757-5107
US

IV. Provider business mailing address

7474 MARKET ST
MACKINAC ISLAND MI
49757-5107
US

V. Phone/Fax

Practice location:
  • Phone: 906-847-3582
  • Fax:
Mailing address:
  • Phone: 906-847-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704356857
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: