Individual
SHANNON GAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23323 87TH ST, SALEM, WI 53168-9437
(262) 977-0070
Mailing address
23323 87TH ST, SALEM, WI 53168-9437
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
041.527344
IL
163WW0000X
Wound Care Registered Nurse
Primary
234239-30
WI
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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