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Individual

SHANNON WALOWSKI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSN, APNP, AGPCNP-BC

Contact information

Practice address
830 N 109TH ST STE 1, WAUWATOSA, WI 53226-3754
(414) 777-1811
(414) 777-1812
Mailing address
830 N 109TH ST, STE 1, WAUWATOSA, WI 53226-3754
(414) 777-1811
(414) 777-1812

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7131-33
WI
363LG0600X
Gerontology Nurse Practitioner
7131-33
WI

Other

Enumeration date
11/26/2016
Last updated
07/21/2022
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