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General NPI Number Information
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NPI Number | 1982476743
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Entity Type | Organization
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Legal Business Name | SHONDA PETERSON
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 20251 HUNT CLUB DR
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City | HARPER WOODS
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State | MI
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Zip | 48225-1761
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Country | US
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Telephone | 313-465-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 20251 HUNT CLUB DR
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City | HARPER WOODS
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State | MI
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Zip | 48225-1761
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Country | US
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Telephone | 313-465-3439
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Fax |
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Authorized Official
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Title or Position | HEALTH AND WELLNESS COACH
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Name | MRS. SHONDA PETERSON
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Credential |
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Telephone | 313-465-3439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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