Healthcare Provider Details

I. General information

NPI: 1699084343
Provider Name (Legal Business Name): VERONICA SHIVACHI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24110 MEADOWBROOK RD SUITE 206
NOVI MI
48375-3459
US

IV. Provider business mailing address

24110 MEADOWBROOK RD SUITE 206
NOVI MI
48375-3459
US

V. Phone/Fax

Practice location:
  • Phone: 888-707-5716
  • Fax: 888-707-5716
Mailing address:
  • Phone: 888-707-5716
  • Fax: 888-707-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704245731
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704245731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: