Individual provider · Type 1 NPI

Shanise Yvonne Petticord

Licensed Practical Nurse · Detroit, MI

NPI number 1700639101 Active

Practice location

5736 Audubon Rd
Detroit, MI 48224-2665

Call (313) 624-1067 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X4703091434 (MI)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1700639101

Shanise Yvonne Petticord's National Provider Identifier is 1700639101, issued on Apr 8, 2024. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Detroit, MI. The record was last updated on Apr 8, 2024.