Provider Demographics
NPI:1891939906
Name:TRIEST-ROBERTSON, SHIRLEY A (APNP)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:A
Last Name:TRIEST-ROBERTSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7707
Mailing Address - Country:US
Mailing Address - Phone:920-655-0103
Mailing Address - Fax:920-468-9764
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-655-0103
Practice Address - Fax:920-468-9764
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3730363L00000X
WI61603-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse