Provider Demographics
NPI:1093419228
Name:LEWIS-HILLSTROM, SHANNON MELISSA
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MELISSA
Last Name:LEWIS-HILLSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23658 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1967
Mailing Address - Country:US
Mailing Address - Phone:989-430-7148
Mailing Address - Fax:
Practice Address - Street 1:23658 THORNTON ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1967
Practice Address - Country:US
Practice Address - Phone:989-430-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula