Provider Demographics
NPI:1023096245
Name:SCHUSTER, ALICE (NP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:SCHUSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38485 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-469-3218
Mailing Address - Fax:586-263-2614
Practice Address - Street 1:15855 NINETEEN MILE RD
Practice Address - Street 2:ST JOSEPHS HEALTHCARE
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-263-2016
Practice Address - Fax:586-263-2614
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:2006-01-10
Deactivation Code:
Reactivation Date:2007-01-24
Provider Licenses
StateLicense IDTaxonomies
MI4704120622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP18997Medicare UPIN