Individual
SHANNON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
6777 W MAPLE RD, DEPARTMENT OF WOMENS HEALTH, WEST BLOOMFIELD, MI 48322-3013
(313) 874-4688
Mailing address
26901 BEAUMONT BLVD, SOUTHFIELD, MI 48033-3849
(248) 577-3313
(248) 577-3302
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
4704216593
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704216593
LICENSE
MI
Enumeration date
02/06/2007
Last updated
01/19/2021
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