Provider Demographics
NPI:1740576032
Name:PUGH, SHEILA NATALIE (LPN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:NATALIE
Last Name:PUGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23435 BRANDYWYNNE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4880
Mailing Address - Country:US
Mailing Address - Phone:586-915-4864
Mailing Address - Fax:
Practice Address - Street 1:23999 NORTHWESTERN HWY
Practice Address - Street 2:#200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2578
Practice Address - Country:US
Practice Address - Phone:248-569-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703078707164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse