Provider Demographics
NPI:1477689883
Name:SHEEN, TABITHA M (APNP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:M
Last Name:SHEEN
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 1:100 15TH AVE.
Mailing Address - Street 2:STE. 180, LAKESHORE MEDICAL CLINIC
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-768-5430
Mailing Address - Fax:414-762-4224
Practice Address - Street 1:2000 E. LAYTON AVE.
Practice Address - Street 2:LAKESHORE MEDICAL CLINIC
Practice Address - City:ST. FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-6053
Practice Address - Country:US
Practice Address - Phone:414-744-6589
Practice Address - Fax:414-747-8848
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108285-30163W00000X
WI2803363L00000X
WI2803-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health