Provider Demographics
NPI:1013747609
Name:TONEY, IMARI ALEXIS
Entity type:Individual
Prefix:
First Name:IMARI
Middle Name:ALEXIS
Last Name:TONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GETTYSBURG RD UNIT 304
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6713
Mailing Address - Country:US
Mailing Address - Phone:313-815-1749
Mailing Address - Fax:
Practice Address - Street 1:426 N INGALLS ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2003
Practice Address - Country:US
Practice Address - Phone:734-763-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704399384163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient