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NPI Code Detail

MEDICARE: MRS. SCHAWANA THAXTON NP

MEDICARE: MRS. SCHAWANA THAXTON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner4704221417MI

General Provider Information

NPI Number : 1306928395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SCHAWANA THAXTON NP
Provider Business Mailing Address
First Line : PO BOX 746723
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6723
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 11260 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3320
Country : US
Telephone Number : 313-749-0148
Fax Number : 313-263-3298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 06/21/2021

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