Individual
MRS. SHANNON LEE KEIDEL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
7420 E WIND LAKE RD, WATERFORD, WI 53185-1512
(262) 895-2692
Mailing address
7420 E WIND LAKE RD, WATERFORD, WI 53185-1512
(262) 895-2692
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39862100
—
WI
Enumeration date
03/29/2006
Last updated
07/09/2007
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