Individual
JESSICA SHANTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
8150 OLD 13 MILE RD, WARREN, MI 48093-8700
(800) 395-3223
(248) 620-6405
Mailing address
6549 TOWN CENTER DR, CLARKSTON, MI 48346-4824
(800) 395-3223
(248) 620-6405
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704267746
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704267746
MI
Other
Enumeration date
11/27/2018
Last updated
08/30/2024
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