Individual
DR. SHAY NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3500
(920) 433-7932
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 423-4100
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
47159-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34554700
—
WI
Enumeration date
11/25/2005
Last updated
04/24/2014
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