Provider Demographics
NPI:1932637444
Name:SHAY, KATRINA MARIE (APNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:SHAY
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 1:4909 W TUMBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8392
Mailing Address - Country:US
Mailing Address - Phone:920-517-0717
Mailing Address - Fax:414-805-6808
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9728
Practice Address - Fax:414-805-6808
Is Sole Proprietor?:No
Enumeration Date:2017-05-28
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI769133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932637444Medicaid
WI769133OtherAPNP STATE LICENSE