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General NPI Number Information
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NPI Number | 1255974390
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Entity Type | Individual
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Provider Name | SHAWN ALLEN WAITERS SR. NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-222-7921
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Fax |
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Provider Business Mailing Address
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Address Line | 929 BIRCHWOOD DR
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City | FLUSHING
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State | MI
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Zip | 48433-1401
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Country | US
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Telephone | 810-845-3045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704224275
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License Number State | MI
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