Provider Demographics
NPI:1831287663
Name:BADAL, SHAWN L (CNP)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:L
Last Name:BADAL
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:30700 TELEGRAPH RD
Mailing Address - Street 2:STE 1536
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4590
Mailing Address - Country:US
Mailing Address - Phone:810-762-7038
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:2700 ROBERT T LONGWAY BLVD
Practice Address - Street 2:STE #A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2190
Practice Address - Country:US
Practice Address - Phone:810-235-2599
Practice Address - Fax:810-235-2836
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704234549363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500B514740OtherBLUE SHIELD
MI4938201Medicaid
MIP23940002Medicare ID - Type Unspecified
MI4938201Medicaid