SHANISE YVONNE PETTICORD
NPI 1700639101
Licensed Practical Nurse in Detroit, MI

Q: What is Shanise Petticord's NPI number?

The NPI number for Shanise Petticord is 1700639101. It was assigned to this individual provider in the NPPES registry on April 8, 2024.

Q: What is Shanise Petticord's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

Q: When was this NPI record last updated?

The NPPES record for Shanise Petticord was last updated on April 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 08, 2024

5736 AUDUBON RD, DETROIT, MI 48224(313) 624-1067 Get Directions Write a Review

NPPES record last updated: April 8, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Shanise Yvonne Petticord NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANISE YVONNE PETTICORD (NPI 1700639101) is an individual licensed practical nurse in Detroit, Michigan, licensed in Michigan (4703091434) and active in the NPI registry since April 2024.

NPPES Registry Identity

NPI1700639101

Entity TypeIndividualFemale

Primary Taxonomy164W00000X

Provider Legal NameSHANISE YVONNE PETTICORD

Location Address5736 AUDUBON RDDetroit, MI 48224-2665

Mailing Address5736 Audubon RdDetroit, MI 48224-2665 · (313) 624-1067

Phone(313) 624-1067

Sole ProprietorNo

Enumeration DateApril 8, 2024

NPPES CertifiedApril 8, 2024

✔ NPI 1700639101 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers

Taxonomy Code164W00000X

License✔ Licensed in MI · 4703091434

Definition

A licensed practical nurse 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.

5736 AUDUBON RD, Detroit, MI 48224

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CO-RECT CO-NECT REPS LLC

Home Health

5736 AUDUBON RD
DETROIT, MI 48224

Wayne County (313) 624-1067

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shanise Petticord's NPI number?

The NPI number for Shanise Petticord is 1700639101. It was assigned to this individual provider in the NPPES registry on April 8, 2024.

Where is Shanise Petticord located?

Shanise Petticord practices at 5736 Audubon Rd, Detroit, MI 48224. The listed phone number is (313) 624-1067.

What is Shanise Petticord's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Shanise Petticord was last updated on April 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.