Shardae Clark

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4708311201 Issued in MI

Practice address

4127 Stone Post Rd
Newport, MI 48166-7830

Phone

(313) 247-9493

NPI assigned

Sep 3, 2015

Last updated

Sep 3, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1295103570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4127 STONE POST RD",
            "city": "NEWPORT",
            "state": "MI",
            "postal_code": "481667830",
            "telephone_number": "313-247-9493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4127 STONE POST RD",
            "city": "NEWPORT",
            "state": "MI",
            "postal_code": "481667830",
            "telephone_number": "313-247-9493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHARDAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4708311201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen R Bell, D.O.
• Lauren Berns
• Bingham Pharmacy LLC
• Katelyn Buettner
• Jessica Chhan, FNP-BC
• Jennifer Ann Cox, PA-C
• Danilo Dona MD PC
• Danilo Agustin Dona, M.D.
• Gina Maria Donnelly, B.A.;J.D.
• Family Medical Center of Michigan,Inc (Family Medical Center Jefferson High School)

• Licensed Practical Nurse in Newport, MI
• Providers in Newport, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.