Provider Demographics
NPI:1598229478
Name:CONNER, SHAINA MARIE (APNP)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:MARIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:MARIE
Other - Last Name:BLACKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:835 S VANBUREN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-884-5460
Mailing Address - Fax:920-884-5475
Practice Address - Street 1:835 S VANBUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-884-5460
Practice Address - Fax:920-884-5475
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177820-30163W00000X
WI9036-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse