Individual
SHANNON M. NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
13133 N PORT WASHINGTON RD STE 204, MEQUON, WI 53097-2420
(262) 243-2524
(262) 243-2525
Mailing address
788 N JEFFERSON ST, SUITE 300/KAAREN BUTZEN, MILWAUKEE, WI 53202-3718
(414) 272-8950
(414) 272-0859
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1516
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326075078
—
WI
Enumeration date
06/27/2006
Last updated
02/24/2021
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