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Individual

SHUBA SAMUEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP, PMHNP

Contact information

Practice address
4650 S HOWELL AVE, MILWAUKEE, WI 53207-5908
(414) 376-5577
Mailing address
718 RANGE ST, MANISTIQUE, MI 49854-1644

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704328312
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4599
WI

Other

Enumeration date
10/21/2011
Last updated
09/26/2024
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