Basic Information
| Provider Information | |||||||||
| NPI: | 1689971814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCATEE | ||||||||
| FirstName: | JONI | ||||||||
| MiddleName: | LAINE | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3429 RENNER DR | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955403104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077262255 | ||||||||
| FaxNumber: | 7079499715 | ||||||||
| Practice Location | |||||||||
| Address1: | 3429 RENNER DR | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955403104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077262255 | ||||||||
| FaxNumber: | 7079499715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2011 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 59752 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A150338 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0001-0207607 | 01 | MEDICA | OTHER | 1689971814 | 01 | MN | BCBS | OTHER | 1689971814 | 05 | MN | MEDICAID |