Provider Demographics
NPI:1881871267
Name:LATONDRESE, HEIDE NIKKO (RN)
Entity type:Individual
Prefix:MRS
First Name:HEIDE
Middle Name:NIKKO
Last Name:LATONDRESE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:HEIDE
Other - Middle Name:NIKKO
Other - Last Name:LATONDRESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:740 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-7813
Mailing Address - Country:US
Mailing Address - Phone:734-240-8400
Mailing Address - Fax:734-240-5363
Practice Address - Street 1:740 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7813
Practice Address - Country:US
Practice Address - Phone:734-240-8400
Practice Address - Fax:734-240-5363
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704179461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse