Individual
SHANNON LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2807 N BALLARD RD, APPLETON, WI 54911-8701
(920) 512-8822
Mailing address
108 LAMINE LN, COMBINED LOCKS, WI 54113-1100
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
13535-33
WI
Other
Enumeration date
08/24/2023
Last updated
02/24/2026
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