Provider Demographics
NPI:1619634045
Name:KING, SHEENA SHARNISE
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:SHARNISE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W HUSTIS ST APT C
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5294
Mailing Address - Country:US
Mailing Address - Phone:414-324-9091
Mailing Address - Fax:
Practice Address - Street 1:8525 W TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3761
Practice Address - Country:US
Practice Address - Phone:414-324-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant