Provider Demographics
NPI:1558445312
Name:LEWANDOSKI, SHARON MARIE-JANSEN (MSN APRN BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE-JANSEN
Last Name:LEWANDOSKI
Suffix:
Gender:F
Credentials:MSN APRN BC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, BC
Mailing Address - Street 1:18302 MIDDLEBELT ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1411
Mailing Address - Country:US
Mailing Address - Phone:248-478-1500
Mailing Address - Fax:248-478-2798
Practice Address - Street 1:18302 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5007
Practice Address - Country:US
Practice Address - Phone:248-478-1500
Practice Address - Fax:248-478-2798
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4708337Medicaid
MI10-4708337Medicaid
MI10-4708337Medicaid
MIMJ1238814OtherDEA