Provider Demographics
NPI:1487265559
Name:SHAH, RITA N (MSN FNP-BC)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:N
Last Name:SHAH
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21510 HARRINGTON ST STE 303
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2378
Mailing Address - Country:US
Mailing Address - Phone:586-741-5346
Mailing Address - Fax:
Practice Address - Street 1:21510 HARRINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2378
Practice Address - Country:US
Practice Address - Phone:586-741-5346
Practice Address - Fax:586-741-8886
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704187764363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care