Shannon Andrews, NP
Individual provider Active NPI Nurse Practitioner · Appleton, WI
NPI 1184040982 · NPPES record last updated Mar 7, 2022
Key facts
- NPI
- 1184040982
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 11551-33 (WI)
- Practice address
- 2600 S Heritage Woods Dr
Appleton, WI 54915-1408 - Phone
- (920) 225-7875
- Fax
- (920) 993-5003
- NPI assigned
- Mar 17, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231111000268 | WI | Order and Referring Only - Nurse Practitioner | 8426443300 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2038-19 | WI | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2038-19 | WI | |
| Nurse Practitioner | 363L00000X | 11551-33 | WI | Yes |
Addresses
Primary practice location
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Mailing address
1280 Lakeview Dr
Green Bay, WI 54313-8824
Other practice location 1
1280 Lakeview Dr
Green Bay, WI 54313-8824
Phone (920) 639-0892
Other providers in Appleton, WI
- Kristin G Anderson
- Michael Floyd Anderson
- William A Anderson
- Joshua Paul Andreini
- Brandi Andrews
- Patricia Ann Angelucci
- Rhonda Joy Anglea
- Wendy Antoine
- Anthony Michael Appl
- Apple Creek LTD
All providers in Appleton, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.