Basic Information
| Provider Information | |||||||||
| NPI: | 1265419048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDFERN | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 N MCCORD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198423000 | ||||||||
| FaxNumber: | 4198423042 | ||||||||
| Practice Location | |||||||||
| Address1: | 2940 N MCCORD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198423000 | ||||||||
| FaxNumber: | 4198423042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704263129 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | NP-08156 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 126519048 | 01 | HPMI | OTHER | 281776607-006 | 01 | OH | MMOH | OTHER | 4724303 | 01 | MI | MICHIGAN MEDICAID | OTHER | 2571935 | 05 | OH | MEDICAID | P00762660 | 01 | OH | RRMC | OTHER |