Individual
MS. SHANICE WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3950 N 74TH ST, MILWAUKEE, WI 53216-1971
(414) 702-8433
Mailing address
3950 N 74TH ST, MILWAUKEE, WI 53216-1971
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
0018099
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W4527809280709
—
WI
Enumeration date
06/22/2020
Last updated
06/22/2020
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