Healthcare Provider Details

I. General information

NPI: 1851295398
Provider Name (Legal Business Name): MARGARET ANNE SHANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 HOLLYWOOD RD STE 270
SAINT JOSEPH MI
49085-9158
US

IV. Provider business mailing address

72 WILEY RD
DOUGLAS MI
49406-5169
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF07260518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: