Provider Demographics
NPI:1043531007
Name:PREVENTATIVE PRIMARY CARE
Entity Type:Organization
Organization Name:PREVENTATIVE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLANDING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:734-225-6507
Mailing Address - Street 1:20600 EUREKA RD STE 522
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5373
Mailing Address - Country:US
Mailing Address - Phone:734-225-6507
Mailing Address - Fax:734-225-6513
Practice Address - Street 1:20600 EUREKA RD STE 522
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5373
Practice Address - Country:US
Practice Address - Phone:734-225-6507
Practice Address - Fax:734-225-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500H258620OtherBCBS
MIMI2477001Medicare PIN