Healthcare Provider Details

I. General information

NPI: 1326769092
Provider Name (Legal Business Name): LAUREN ALEXANDRA SHADDOX APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 200
ROCHESTER HILLS MI
48307-6116
US

IV. Provider business mailing address

585 DORCHESTER WAY
MILFORD MI
48381-2791
US

V. Phone/Fax

Practice location:
  • Phone: 248-997-5805
  • Fax:
Mailing address:
  • Phone: 970-708-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704427387
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1096846
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704427387
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number872512
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: