Healthcare Provider Details

I. General information

NPI: 1699009712
Provider Name (Legal Business Name): SHEILA JOAN LINDAMOOD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 02/14/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

6777 WEST MAPLE RD HENRY FORD HOSPITAL
WEST BLOOMFILED MI
48322-3031
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax:
Mailing address:
  • Phone: 248-325-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704190215
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: