Provider Demographics
NPI:1386206431
Name:OUIMET, SHANNON M (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:OUIMET
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43184 DEQUINDRE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1709
Mailing Address - Country:US
Mailing Address - Phone:586-580-0280
Mailing Address - Fax:586-580-0281
Practice Address - Street 1:43184 DEQUINDRE RD STE 202
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:586-580-0280
Practice Address - Fax:586-580-0281
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704314315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty