Healthcare Provider Details

I. General information

NPI: 1699742148
Provider Name (Legal Business Name): JANET M SHANAHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 ELLIOTT DR
YPSILANTI MI
48197-8633
US

IV. Provider business mailing address

5325 ELLIOTT DR SUITE 203
YPSILANTI MI
48197-8633
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8000
  • Fax: 734-712-4319
Mailing address:
  • Phone: 734-712-8000
  • Fax: 734-712-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number4704176447
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704176447
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: