Provider Demographics
NPI:1952049009
Name:STANLEY, SHAWANNA J
Entity Type:Individual
Prefix:
First Name:SHAWANNA
Middle Name:J
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 N WATER ST STE 414
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2557
Mailing Address - Country:US
Mailing Address - Phone:414-882-0714
Mailing Address - Fax:
Practice Address - Street 1:1433 N WATER ST STE 414
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2557
Practice Address - Country:US
Practice Address - Phone:414-882-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care