Individual
MR. SHANE MICHAEL PEOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
1030 COUNTRYSIDE DR, DE PERE, WI 54115-1835
(920) 609-9883
Mailing address
1030 COUNTRYSIDE DR, DE PERE, WI 54115-1835
(920) 609-9883
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
168533-030
WI
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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