Individual
SHANNON MARCETIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(313) 450-4500
Mailing address
2419 RIVERSIDE DR APT C102, TRENTON, MI 48183-2754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704313073
MI
363LF0000X
Family Nurse Practitioner
Primary
4704313073
MI
Other
Enumeration date
10/24/2016
Last updated
03/26/2021
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