Provider Demographics
NPI:1073068714
Name:SHORES, SAVANNAH (APNP)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:SHORES
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N16W24131 RIVERWOOD DR
Mailing Address - Street 2:CANCER CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1106
Mailing Address - Country:US
Mailing Address - Phone:262-696-5690
Mailing Address - Fax:262-696-0769
Practice Address - Street 1:N16W24131 RIVERWOOD DR
Practice Address - Street 2:CANCER CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1106
Practice Address - Country:US
Practice Address - Phone:262-696-5690
Practice Address - Fax:262-696-0769
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner