Provider Demographics
NPI:1164470084
Name:MEADE, SHAWN THOMAS (RN)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:THOMAS
Last Name:MEADE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10869 HOME SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9562
Mailing Address - Country:US
Mailing Address - Phone:734-238-6568
Mailing Address - Fax:
Practice Address - Street 1:10869 HOME SHORE DR
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-9562
Practice Address - Country:US
Practice Address - Phone:734-238-6568
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208209163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse