Provider Demographics
NPI:1548307705
Name:SHULL, ANDREA (NP CNM)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SHULL
Suffix:
Gender:F
Credentials:NP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12988 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LACHINE
Mailing Address - State:MI
Mailing Address - Zip Code:49753-9663
Mailing Address - Country:US
Mailing Address - Phone:989-464-0166
Mailing Address - Fax:
Practice Address - Street 1:12988 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:LACHINE
Practice Address - State:MI
Practice Address - Zip Code:49753-9663
Practice Address - Country:US
Practice Address - Phone:989-464-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704104693363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health