Healthcare Provider Details

I. General information

NPI: 1407553704
Provider Name (Legal Business Name): CHONTEL LASHAWN WHITFIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD
DETROIT MI
48238-3710
US

IV. Provider business mailing address

29804 ELMGROVE ST
SAINT CLAIR SHORES MI
48082-1866
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-4890
  • Fax:
Mailing address:
  • Phone: 313-717-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704354615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: