Provider Demographics
NPI:1033689633
Name:SCHWARTZ, SHANNON DEANNE (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DEANNE
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DEANNE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3592 S TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54173-8264
Mailing Address - Country:US
Mailing Address - Phone:920-412-6584
Mailing Address - Fax:
Practice Address - Street 1:2360A DUCK CREEK PKWY STE 2
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3377
Practice Address - Country:US
Practice Address - Phone:920-301-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI244009-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse