| Doctor Name: | MRS. CARLA ELYSE SHOCK |
| NPI Number: | 1245339290 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, MSN, APRN-BC |
| License Number: | 4704159521 |
| Business Practice Address: | 26755 Ballard St Harrison Township, MI - 480452419 |
| Business Phone Number: | 5864665464 |
| Business Fax Number: | 5864665352 |
| Mailing Address: | 26755 Ballard St, HARRISON TOWNSHIP |
| State: | MI |
| Postal Code: | 480452419 |
| Phone Number: | 5864665464 |
| Fax Number: | 5864665352 |
| NPI Enumeration Date: | 09/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 4704159521 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |