Provider Demographics
NPI:1427000280
Name:SHANNON, MEG (NP)
Entity Type:Individual
Prefix:MS
First Name:MEG
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:SHANNON-STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:CARDIOTHORACIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-6980
Mailing Address - Fax:414-955-6204
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:CARDIOTHORACIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-6980
Practice Address - Fax:414-955-6204
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77437363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000226KOtherHUMANA
WI1427000280Medicaid
002000226KOtherHUMANA
WI087H73601Medicare PIN