Healthcare Provider Details

I. General information

NPI: 1104167188
Provider Name (Legal Business Name): JAMES IDONI R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S LAPEER RD
OXFORD MI
48371-6108
US

IV. Provider business mailing address

PO BOX 878
FENTON MI
48430-0878
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-9932
  • Fax: 248-969-0840
Mailing address:
  • Phone: 517-546-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704286966
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: