Provider Demographics
NPI:1003381500
Name:HINDMON-HARRIS, THEONNA MONIQUE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:THEONNA
Middle Name:MONIQUE
Last Name:HINDMON-HARRIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:21700 NORTHWESTERN HWY STE 815
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4922
Mailing Address - Country:US
Mailing Address - Phone:248-557-3337
Mailing Address - Fax:248-557-3339
Practice Address - Street 1:21700 NORTHWESTERN HWY STE 815
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4922
Practice Address - Country:US
Practice Address - Phone:248-557-3337
Practice Address - Fax:248-557-3339
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily