Basic Information
| Provider Information | |||||||||
| NPI: | 1023096245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHUSTER | ||||||||
| FirstName: | ALICE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38485 MANCHESTER ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864693218 | ||||||||
| FaxNumber: | 5862632614 | ||||||||
| Practice Location | |||||||||
| Address1: | 15855 NINETEEN MILE RD | ||||||||
| Address2: | ST JOSEPHS HEALTHCARE | ||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862632016 | ||||||||
| FaxNumber: | 5862632614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/10/2006 | ||||||||
| NPIReactivationDate: | 01/24/2007 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704120622 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.