Healthcare Provider Details

I. General information

NPI: 1033821996
Provider Name (Legal Business Name): SHREEN MARINI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 06/29/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MONROE ST STE 206
DEARBORN MI
48124-2950
US

IV. Provider business mailing address

4614 CURTIS ST
DEARBORN MI
48126-4152
US

V. Phone/Fax

Practice location:
  • Phone: 313-757-7647
  • Fax:
Mailing address:
  • Phone: 313-670-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704330311
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704330311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: