Individual
SHANNON L KOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1531 S MADISON ST, APPLETON, WI 54915
(920) 996-3700
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1604
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41978400
—
WI
Enumeration date
09/27/2006
Last updated
01/18/2022
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