Provider Demographics
NPI:1679690895
Name:SHOOK, NANCY ALLEN (RN, LCSW, APNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ALLEN
Last Name:SHOOK
Suffix:
Gender:F
Credentials:RN, LCSW, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E OLIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1468
Mailing Address - Country:US
Mailing Address - Phone:608-265-9438
Mailing Address - Fax:
Practice Address - Street 1:122 E OLIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1487
Practice Address - Country:US
Practice Address - Phone:608-265-9438
Practice Address - Fax:608-263-4681
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71671231041C0700X
WI48973030163W00000X
WI2366033364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41188400Medicaid
WI41188400Medicaid