Individual
KRYSTAL ROSE SHOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22631 GREATER MACK AVE STE 100, SAINT CLAIR SHORES, MI 48080-2055
(586) 800-0086
(586) 800-0087
Mailing address
PO BOX 4236, SOUTHFIELD, MI 48037-4236
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704381967
MI
Other
Enumeration date
07/31/2026
Last updated
07/31/2026
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