Active NPI
Andrea Shull, NP CNM
- Women's Health Nurse Practitioner
- Lachine, MI
National Provider Identifier
1548307705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 4704104693
- Practice address
- 12988 Greenwood Rd
Lachine, MI 49753-9663 - Phone
- (989) 464-0166
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 4704104693 | MI | Primary |
Addresses
Primary practice location
12988 Greenwood Rd
Lachine, MI 49753-9663
Mailing address
12988 Greenwood Rd
Lachine, MI 49753-9663
Phone (989) 464-0166
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Midwife, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704104693 | MI | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238112000000",
"number": "1548307705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12988 GREENWOOD RD",
"city": "LACHINE",
"state": "MI",
"postal_code": "497539663",
"telephone_number": "989-464-0166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12988 GREENWOOD RD",
"city": "LACHINE",
"state": "MI",
"postal_code": "497539663",
"telephone_number": "989-464-0166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULL",
"first_name": "ANDREA",
"credential": "NP CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2009-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "MI",
"license": "4704104693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lachine, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.