Provider Demographics
NPI:1265419048
Name:REDFERN, SHIRLEY (CNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:REDFERN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3042
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3042
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263129363L00000X
OHNP-08156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2571935Medicaid
126519048OtherHPMI
OH281776607-006OtherMMOH
OHP00762660OtherRRMC
MI4724303OtherMICHIGAN MEDICAID
OH2571935Medicaid
MIMI1635014Medicare PIN
OHRENP25124Medicare PIN