Provider Demographics
NPI:1972002533
Name:VILS, SHANNON CORINNE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CORINNE
Last Name:VILS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9706 STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:MAZOMANIE
Mailing Address - State:WI
Mailing Address - Zip Code:53560-9764
Mailing Address - Country:US
Mailing Address - Phone:608-515-6186
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI240014163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse