Individual
SHANNON K CARMONA MOSES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4855 S MOORLAND RD FL 3, NEW BERLIN, WI 53151-7494
(262) 432-7599
(262) 432-7694
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4680-033
WI
363LA2200X
Adult Health Nurse Practitioner
4680-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932485489
—
WI
Enumeration date
10/28/2011
Last updated
06/18/2020
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