Healthcare Provider Details

I. General information

NPI: 1407798903
Provider Name (Legal Business Name): GINGER SHRADER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W LAKE LANSING RD STE 100
EAST LANSING MI
48823-8661
US

IV. Provider business mailing address

221 W LAKE LANSING RD STE 100
EAST LANSING MI
48823-8661
US

V. Phone/Fax

Practice location:
  • Phone: 989-494-1539
  • Fax: 833-740-3674
Mailing address:
  • Phone: 989-494-1539
  • Fax: 833-740-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GINGER MARIE SHRADER
Title or Position: OWNER
Credential: PMHNP
Phone: 989-494-1539