Individual
MS. SHELLY LYNN EAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-0001
(608) 263-6420
(608) 263-0440
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
(608) 829-5485
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
144314-030
WI
363LP0200X
Pediatric Nurse Practitioner
Primary
4446-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38352100
—
WI
Enumeration date
01/05/2007
Last updated
11/04/2015
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