MEDICARE: MRS. MARY JO OLDFORD N.P.

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	363L00000X	Nurse Practitioner	4704164813	MI

General Provider Information

NPI Number	:	1114197167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JO OLDFORD N.P.

Provider Business Mailing Address
First Line	:	4181 WINDMILL FARMS
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-4279
Country	:	US
Telephone Number	:	248-804-4323
Fax Number	:	248-685-0156

Provider Business Practice Location Address
First Line	:	4181 WINDMILL FARMS
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-4279
Country	:	US
Telephone Number	:	248-804-4323
Fax Number	:	248-685-0156

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	04/03/2012

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