Provider Demographics
NPI:1346944402
Name:MILLER, SHANNON (MSN, APNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSN, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ROSS AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6104
Mailing Address - Country:US
Mailing Address - Phone:715-359-8725
Mailing Address - Fax:
Practice Address - Street 1:320 ROSS AVE STE 14
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-6104
Practice Address - Country:US
Practice Address - Phone:715-359-8725
Practice Address - Fax:715-355-7966
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13785-33363LA2200X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management