Provider Demographics
NPI:1114197167
Name:OLDFORD, MARY JO (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:OLDFORD
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:4181 WINDMILL FARMS
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-4279
Mailing Address - Country:US
Mailing Address - Phone:248-804-4323
Mailing Address - Fax:248-685-0156
Practice Address - Street 1:4181 WINDMILL FARMS
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48380-4279
Practice Address - Country:US
Practice Address - Phone:248-804-4323
Practice Address - Fax:248-685-0156
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704164813363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner