Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704210466 | MI |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704210466 | MI |
NPI | 1164669883 |
---|---|
Provider Name | Stacey Anne Shimones |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 06/02/2015 |