Provider Demographics
NPI:1447036660
Name:ICHITEY, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ICHITEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 KASSERINE PASS
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-6482
Mailing Address - Country:US
Mailing Address - Phone:415-530-7795
Mailing Address - Fax:
Practice Address - Street 1:751 KASSERINE PASS
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-6482
Practice Address - Country:US
Practice Address - Phone:415-530-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide