Healthcare Provider Details

I. General information

NPI: 1467857649
Provider Name (Legal Business Name): FURHA SHUTTARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N ROSE ST STE 200
KALAMAZOO MI
49007-3860
US

IV. Provider business mailing address

50 S B B KING BLVD
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 866-949-0108
  • Fax:
Mailing address:
  • Phone: 901-422-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704259558
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: