Healthcare Provider Details

I. General information

NPI: 1023709623
Provider Name (Legal Business Name): SHONNA WARE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14939 SENECA
REDFORD MI
48239-3027
US

IV. Provider business mailing address

PO BOX 18089
RIVER ROUGE MI
48218-0089
US

V. Phone/Fax

Practice location:
  • Phone: 734-658-6333
  • Fax:
Mailing address:
  • Phone: 734-658-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704218945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: