Provider Demographics
NPI:1467699215
Name:PIENTOK, SHAWNA RAE (RN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RAE
Last Name:PIENTOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:WI
Mailing Address - Zip Code:54612-1626
Mailing Address - Country:US
Mailing Address - Phone:608-797-6640
Mailing Address - Fax:
Practice Address - Street 1:305 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:WI
Practice Address - Zip Code:54616-9365
Practice Address - Country:US
Practice Address - Phone:608-989-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157875-030163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health