1730521774 NPI number — MRS. SHIRYL DEEN FOUANI CERTIFIED NURSE ASIS

Table of content: MRS. SHIRYL DEEN FOUANI CERTIFIED NURSE ASIS (NPI 1730521774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730521774 NPI number — MRS. SHIRYL DEEN FOUANI CERTIFIED NURSE ASIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOUANI
Provider First Name:
SHIRYL
Provider Middle Name:
DEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED NURSE ASIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730521774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81153 BURLINGAME ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-444-3493
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4553 MEAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-850-7109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , with the licence number:  230014007150308 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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