Individual
O'DONIS J PERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 W MEM DR, HOUGHTON, MI 49931-2475
(906) 482-9404
Mailing address
901 W MEM DR, HOUGHTON, MI 49931-2475
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704319068
MI
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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