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General NPI Number Information
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NPI Number | 1902121361
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Entity Type | Individual
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Provider Name | CHARISSA ALICE BREDOW-SHAWCROSS NP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 18917 JOY RD
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City | DETROIT
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State | MI
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Zip | 48228-3050
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Country | US
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Telephone | 313-581-7773
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Fax | 313-581-7793
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Provider Business Mailing Address
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Address Line | 18917 JOY RD
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City | DETROIT
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State | MI
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Zip | 48228-3050
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Country | US
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Telephone | 313-581-7773
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Fax | 313-581-7793
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704115714
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License Number State | MI
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