Provider Demographics
NPI:1679631675
Name:SHOLL, SALLY (RN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SHOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:SEMLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:717 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1644
Practice Address - Country:US
Practice Address - Phone:608-576-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI59130-030163WP0200X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics