Healthcare Provider Details

I. General information

NPI: 1609140102
Provider Name (Legal Business Name): SHAWNTINA FLOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHERRY ST SE
GRAND RAPIDS MI
49503-4526
US

IV. Provider business mailing address

765 E. WEDGEWOOD BLVD.
NORTH MUSKEGON MI
49445
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-8200
  • Fax: 616-940-5360
Mailing address:
  • Phone: 231-855-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: