Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704297190 | MI |
NPI | 1023653797 |
---|---|
Provider Name | Ms. Lauren Ashley Shailor |
First Address | Troy, MI 48083-1219 |
Second Address | Warren, MI 48093-3472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2019 |
Last Update Date | 16/11/2019 |