Shana Clark, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704307625 Issued in MI

Practice address

25900 Greenfield Rd Ste 414
Oak Park, MI 48237-1267

Phone

(248) 242-1193

NPI assigned

Aug 17, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Purpose Home & Hospice Care LLC

  • Non-emergency Medical Transport (VAN)
  • Oak Park, MI
  • NPI 1386290328
  NPD
• Purpose Home & Hospice Care LLC

  dba Purpose Lab Services

  • Clinical Medical Laboratory
  • Oak Park, MI
  • NPI 1891446894
  NPD

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597622400000",
    "number": "1861004319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23745 ROCKINGHAM ST",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480337025",
            "telephone_number": "248-242-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25900 GREENFIELD RD STE 414",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482371267",
            "telephone_number": "248-242-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-17",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704307625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8848947",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Choice Independence Inc.
• Christina L Kimbrough PLLC
• Circle of Life
• Aimee Cisler
• Gregory Q. Clague, D.O.
• Shanell Clark
• Amanda Clay
• Clear Choice Lab Solutions LLC
• Close Family Home Care, LLC
• Patrice Coates

• Registered Nurse in Oak Park, MI
• Providers in Oak Park, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; 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.