Provider Demographics
NPI:1497725550
Name:MICKEY, JAMES W (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:MICKEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42536 DEVANT CIR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8160
Mailing Address - Country:US
Mailing Address - Phone:951-506-7678
Mailing Address - Fax:
Practice Address - Street 1:42536 DEVANT CIR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8160
Practice Address - Country:US
Practice Address - Phone:951-506-7678
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505750163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine