JESSICA SHANTZ (NPI# 1790255248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790255248 |
| Entity Type | Individual |
| Full Name | JESSICA SHANTZ |
| Credential | PMHNP |
| Practice Address |
28800 Ryan Rd Ste 320 Warren MI 48092-4272 |
| Mailing Address |
26029 Continental Cir Taylor MI 48180-6900 |
| Practice Telephone | 5865820500 |
| Practice Fax Number | 5868342231 |
| Mailing Telephone | 7348915046 |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
4704267746 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
28800 RYAN RD STE 320 |
| City | WARREN |
| State | MI |
| Zip Code | 48092-4272 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699012229 | Lynne Strachan | Physician Assistant | 28800 Ryan Rd Ste 320, Warren, MI 48092-4269 | 2013-01-16 |
| 1710549571 | Kaitlyn Marie Barner | Social Worker | 28800 Ryan Rd Ste 320, Warren, MI 48092-4272 | 2019-07-02 |
| 1255844023 | Letricia Lenise Clark | Nurse Practitioner | 28800 Ryan Rd Ste 320, Warren, MI 48092-4272 | 2017-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881163186 | Katherine Byrd | Behavior Technician | 3691 East 11 Mile Rd., Warren, MI 48092 | 2018-11-15 |
| 1861980302 | Mark Paul Azzo | Home Health Aide | 27605 Walker Ave, Warren, MI 48092 | 2018-04-30 |
| 1144747130 | Joseph Galutan Estrada | Chiropractor | 4846 Marlow Dr, Warren, MI 48092 | 2017-08-29 |
| 1649669425 | Lawrence Mosurak IIi | Chiropractor | 6201 Chicago Road, Warren, MI 48092 | 2015-01-15 |
| 1174911713 | Kimberly A Ott | Nurse Practitioner | 28800 Ryan Rd Suite 320, Warren, MI 48092 | 2015-01-06 |
| 1487071999 | Michele Szandzik | Chiropractor | 2243 East 12 Mile Rd, Warren, MI 48092 | 2014-03-21 |
| 1962827311 | Mouradian Dental Center, D.d.s., P.C. | Dentist | 32500 Mound Rd., Mouradian Dental Center, D.d.s., P.C., Warren, MI 48092 | 2014-02-21 |
| 1639495930 | Debra Kay Wenneman | Physical Therapist | 28776 Ryan Rd, Warren, MI 48092 | 2010-04-12 |
| 1922332923 | Sonia Amirali Pethani | Physical Therapist | 2117 E. Eleven Mile Rd., Warren, MI 48092 | 2009-09-23 |
| 1881822237 | Michael Patrick Walsh | Orthopaedic Surgery | 28800 Ryan Rd Ste 310, Warren, MI 48092 | 2009-06-24 |
| Find all providers in zip 48092 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750992319 | Katherine Elizabeth Loffredo | Nurse Practitioner | 74 Seymour St, Warren, RI 02885-4227 | 2020-08-16 |
| 1306455860 | Wendy Michelle Ray | Nurse Practitioner | 1012 E Church St Ste A, Warren, AR 71671-3530 | 2020-07-29 |
| 1124679725 | Aprille Palac Mangalonzo | Nurse Practitioner | 14 Hillcrest Blvd, Warren, NJ 07059-5116 | 2019-09-25 |
| 1831505577 | Mary Grace Hall | Nurse Practitioner | 103 W Market St, Warren, OH 44481-1017 | 2014-07-02 |
| 1114548468 | Karen Marie Kline | Nurse Practitioner | 514 W 3rd Ave, Warren, PA 16365-2245 | 2020-04-28 |
| 1891321428 | Brandi Kaufman | Nurse Practitioner | 8577 E Market St, Warren, OH 44484-2345 | 2020-03-16 |
| 1720620198 | Elizabeth Miller | Nurse Practitioner | 150 E Market St, Warren, OH 44481-1141 | 2019-10-17 |
| 1538712922 | Zach Aldridge | Nurse Practitioner | 150 E Market St, Warren, OH 44481-1141 | 2019-07-24 |
| 1396202412 | Tammy A Klinefelter | Nurse Practitioner | 3120 W Market St, Warren, OH 44485-3069 | 2019-02-25 |
| 1255844023 | Letricia Lenise Clark | Nurse Practitioner | 28800 Ryan Rd Ste 320, Warren, MI 48092-4272 | 2017-11-14 |
| Find all providers in WARREN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.