Individual
SHANNON GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2357 W MASON ST, GREEN BAY, WI 54303-4708
(192) 026-5570
Mailing address
2357 W MASON ST, GREEN BAY, WI 54303-4708
(192) 026-5570
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
320921-31
WI
Other
Enumeration date
09/26/2022
Last updated
09/26/2022
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