Provider Demographics
NPI:1437819356
Name:WATSON, SHIMIKA S
Entity Type:Individual
Prefix:
First Name:SHIMIKA
Middle Name:S
Last Name:WATSON
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 1:9944 BRAMELL
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1304
Mailing Address - Country:US
Mailing Address - Phone:734-657-0891
Mailing Address - Fax:
Practice Address - Street 1:9944 BRAMELL
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1304
Practice Address - Country:US
Practice Address - Phone:734-657-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide