Provider Demographics
NPI:1780184002
Name:KEIFFER, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KEIFFER
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 1:29332 JACQUELYN DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4557
Mailing Address - Country:US
Mailing Address - Phone:734-522-3924
Mailing Address - Fax:
Practice Address - Street 1:29332 JACQUELYN DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4557
Practice Address - Country:US
Practice Address - Phone:734-522-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse