MEDICARE: MARIE SHOULDERS-WILLIAMS FNP

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
1	363LF0000X	Family Nurse Practitioner	4704177625	MI

General Provider Information

NPI Number	:	1851547038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE SHOULDERS-WILLIAMS FNP

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-887-4806
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 E 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-2112
Country	:	US
Telephone Number	:	313-372-5974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	12/01/2025

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