Provider Demographics
NPI:1770897084
Name:WISHKA, SHAUNA BRIANNE (PA-C)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:BRIANNE
Last Name:WISHKA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:560 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3720
Mailing Address - Country:US
Mailing Address - Phone:231-733-8679
Mailing Address - Fax:231-733-8691
Practice Address - Street 1:12330 JAMES ST
Practice Address - Street 2:H-10
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8689
Practice Address - Country:US
Practice Address - Phone:616-582-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2017-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant