Provider Demographics
NPI:1679041545
Name:NIXON, SHIBA LASHON (PMHNP)
Entity type:Individual
Prefix:MS
First Name:SHIBA
Middle Name:LASHON
Last Name:NIXON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29781 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1859
Mailing Address - Country:US
Mailing Address - Phone:313-550-9605
Mailing Address - Fax:
Practice Address - Street 1:NEW OAKLAND
Practice Address - Street 2:6549 TOWN CENTER SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-620-6400
Practice Address - Fax:248-620-6405
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704264372163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty