Healthcare Provider Details

I. General information

NPI: 1962747311
Provider Name (Legal Business Name): SHELIA THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELIA MARCEL MCBRIDE

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 LAPEER RD
FLINT MI
48503-4482
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-742-2060
  • Fax:
Mailing address:
  • Phone: 810-424-2011
  • Fax: 810-249-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704194122
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704194122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: