Individual
SHANNON KATHLEEN COUSINEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
14165 N FENTON RD STE 201A, FENTON, MI 48430-1584
(810) 853-5875
Mailing address
4724 GREEN MEADOW LN, ROCHESTER, MI 48306-1754
(847) 791-2015
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704348540
MI
363LF0000X
Family Nurse Practitioner
Primary
4704348540
MI
Other
Enumeration date
06/24/2020
Last updated
05/15/2023
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