Individual
MR. CONRAD SHAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
110 S EAST ST, LA VALLE, WI 53941-8525
(608) 415-1696
Mailing address
PO BOX 352, LA VALLE, WI 53941-0352
(608) 415-1696
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
152058
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35011300
—
WI
Enumeration date
10/01/2008
Last updated
10/01/2008
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