NATISHA IRENE CLARK (NPI# 1871957985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1871957985 |
Entity Type | Individual |
Full Name | NATISHA IRENE CLARK |
Practice Address |
15150 Fort St Southgate MI 48195-1302 |
Practice Telephone | 7342824800 |
Practice Fax Number | 7342825039 |
Mailing Telephone | 7342824800 |
Mailing Fax Number | 7342825039 |
Enumeration Date | 2016-04-06 |
Last Update Date | 2017-02-13 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163W00000X | Registered Nurse | 4704278418 | MI | Nursing Service Providers |
Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
4704278418 | MI | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MI | 1871957985 | 05 | |
MI | BLUE CROSS BLUE SHEILD | 1871957985 | 01 |
Street Address |
15150 FORT ST |
City | SOUTHGATE |
State | MI |
Zip Code | 48195-1302 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699777995 | Mustafa A Hashem | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2005-06-01 |
1629693791 | Diana Bischer | Nurse Practitioner | 15150 Fort St, Southgate, MI 48195-1302 | 2020-06-14 |
1104390350 | Daniel Fenderson | Nurse Practitioner | 15150 Fort St, Southgate, MI 48195-1302 | 2019-01-21 |
1871958744 | Saba Madhoun | Physician Assistant | 15150 Fort St, Southgate, MI 48195-1302 | 2015-12-21 |
1437415874 | Mashkur Husain | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2012-04-10 |
1396976080 | Ashraf Ehab Mostafa | Internal Medicine | 15150 Fort St, Southgate, MI 48195 | 2009-07-29 |
1225294168 | Qaiser Shafiq | Internal Medicine | 15150 Fort St, Southgate, MI 48195 | 2008-07-30 |
1568620003 | Nitin K. Gupta | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2008-05-31 |
1578767950 | Ameen A Abdulmalik | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2007-06-12 |
1598968547 | Abdulwahhab Alroaini | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2007-06-07 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780206656 | Destiny D Harris | Social Worker | 14799, Southgate, MI 48195 | 2020-05-13 |
1285102368 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 16256 Fort St, Southgate, MI 48195 | 2018-11-07 |
1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
1255824025 | Kiesta Janell Lindsey | Social Worker | 13101 Allen Rd Bldg 4-f, Southgate, MI 48195 | 2018-06-07 |
1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
1275069486 | Liza Du Plessis | Student in an Organized Health Care Education/Training Program | 13111 Allen Road, Southgate, MI 48195 | 2017-05-08 |
1497290456 | Beaumont Health | Clinic/Center | 15777 Northline, Southgate, MI 48195 | 2016-12-30 |
1184172876 | Felicia Wilson | Licensed Practical Nurse | 15771 Wildemere, Southgate, MI 48195 | 2016-09-12 |
1225487978 | Stacey Petrick-strickland | Technician, Other | 12189 Agnes, Southgate, MI 48195 | 2016-06-03 |
1205298486 | Ashley Francis | Hearing Instrument Specialist | 18800 Eureka Rd., Southgate, MICHIGAN 48195 | 2016-03-25 |
Find all providers in zip 48195 |
Taxonomy Code | 363LP2300X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Primary Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912490129 | Lekisha R Weathersby | Nurse Practitioner | 13667 Eureka Rd, Southgate, MI 48195-1332 | 2018-06-12 |
1649770652 | Valeria Concetta Smith | Nurse Practitioner | 15750 Northline Rd, Southgate, MI 48195-2378 | 2018-02-16 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447859731 | Cindy Clare Craig | Nurse Practitioner | 4142 Cranberry Ln, Williamsburg, MI 49690-8641 | 2020-10-19 |
1487269536 | Christiane Ines Atowo | Nurse Practitioner | 25420 5 Mile Rd, Redford, MI 48239-3837 | 2020-09-14 |
1760095137 | Gina Louise Bennett | Nurse Practitioner | 4871 Harwood Rd, Ionia, MI 48846-9422 | 2020-08-26 |
1356953756 | John Westley Mailey Jr. | Nurse Practitioner | 27645 Albert St, Novi, MI 48374-1012 | 2020-08-18 |
1356951305 | Michelle Lynn Andriacchi | Nurse Practitioner | 45690 Kenmore St, Shelby Township, MI 48317-4656 | 2020-08-05 |
1124646476 | Chand Sheoran | Nurse Practitioner | 3040 Albany Ct, Troy, MI 48083-2595 | 2020-07-13 |
1104449214 | Lynn Marie Alexanders-klima | Nurse Practitioner | 6697 Summerdale Ct E, Ypsilanti, MI 48197-6140 | 2020-05-22 |
1326660580 | Kristin A Furwa | Nurse Practitioner | 600 Health Park Blvd Ste H, Grand Blanc, MI 48439-2558 | 2020-05-11 |
1700412582 | Ashley Ruth Zimmerman | Nurse Practitioner | 6223 Brant Ln, Ypsilanti, MI 48197-8742 | 2020-03-12 |
1992339139 | Afusat Ahmed | Nurse Practitioner | 5231 Madison Ave Apt A5, Okemos, MI 48864-1172 | 2020-02-26 |
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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.