Healthcare Provider Details

I. General information

NPI: 1316673379
Provider Name (Legal Business Name): SHAHLA FORCON ALHUK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 10/22/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 ROOKERY DR
ROCHESTER HILLS MI
48309-4519
US

IV. Provider business mailing address

2076 ROOKERY DR
ROCHESTER HILLS MI
48309-4519
US

V. Phone/Fax

Practice location:
  • Phone: 248-797-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704303318
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704303318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: