Provider Demographics
NPI:1700368925
Name:MORGAN, SHELBY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:MAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4050 W MAPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3118
Mailing Address - Country:US
Mailing Address - Phone:734-956-6336
Mailing Address - Fax:
Practice Address - Street 1:20490 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-3955
Practice Address - Country:US
Practice Address - Phone:734-956-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307014163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse