Individual provider Active NPI

Shannon I Pham, NP

  • Family Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1295321370
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F06201040 Issued in WI
Practice address
1506 S Oneida St
Appleton, WI 54915-1305
Phone
(920) 738-2000
NPI assigned
Dec 14, 2020
Last updated
Oct 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F06201040 WI Primary

Addresses

Primary practice location

1506 S Oneida St
Appleton, WI 54915-1305

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other practice location 1

800 Riverside Dr
Waupaca, WI 54981-1943
Phone (715) 258-1041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210302003045 WI Practitioner - Nurse Practitioner 9638585458 Reassigns benefits to 13 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F06201040WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Wild Rose, Inc CurrentSince Jan 24, 2026 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Aug 5, 2025 Accepting new patients
Ascension Calumet Hospital, Inc CurrentSince Oct 4, 2021 Accepting new patients
Thedacare Medical Center - Shawano, Inc. CurrentSince Aug 5, 2025 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. CurrentSince Aug 5, 2025 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Thedacare Medical Center - Waupaca, Inc. CurrentSince Aug 5, 2025 Accepting new patients
Richard S Veiga MD SC Current Accepting new patients

Locations

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

601 Grove Ave
Wild Rose, WI 54984
Phone (920) 622-3257

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1295321370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 S ONEIDA ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151305",
            "telephone_number": "920-738-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Waupaca",
            "state": "WI",
            "postal_code": "549811943",
            "country_code": "US",
            "telephone_number": "715-258-1041",
            "fax_number": "715-258-1042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "SHANNON",
        "middle_name": "I",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-14",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "F06201040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.