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General NPI Number Information
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NPI Number | 1952712598
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Entity Type | Individual
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Provider Name | DOLORES SHANK RN
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Gender | Female
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/17/2014
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Provider Practice Location Address
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Address Line | 17141 RYAN RD
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City | DETROIT
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State | MI
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Zip | 48212-1112
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Country | US
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Telephone | 313-733-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 370 W DAWSON RD
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City | MILFORD
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State | MI
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Zip | 48381-2709
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Country | US
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Telephone | 248-685-2197
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 4704209742
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License Number State | MI
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