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NPI Code Detail

MEDICARE: MS. CHARISSA ALICE BREDOW-SHAWCROSS NP

MEDICARE: MS. CHARISSA ALICE BREDOW-SHAWCROSS 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 Practitioner4704115714MI

General Provider Information

NPI Number : 1902121361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHARISSA ALICE BREDOW-SHAWCROSS NP
Provider Business Mailing Address
First Line : 18917 JOY RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-3050
Country : US
Telephone Number : 313-581-7773
Fax Number : 313-581-7793
Provider Business Practice Location Address
First Line : 18917 JOY RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-3050
Country : US
Telephone Number : 313-581-7773
Fax Number : 313-581-7793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2010
Last Update Date : 08/05/2016

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