Provider Demographics
NPI:1811409162
Name:SHIMEALL, ELIZABETH J (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:SHIMEALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9697 SAINT CATHERINES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2118
Mailing Address - Country:US
Mailing Address - Phone:262-656-3590
Mailing Address - Fax:262-656-3591
Practice Address - Street 1:9697 SAINT CATHERINES DR STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2118
Practice Address - Country:US
Practice Address - Phone:262-656-3590
Practice Address - Fax:262-656-3591
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4012-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4012-23OtherWI LICENSE
WIK400441598OtherMEDICARE