Mary Alice Shofner, RN
Individual provider Active NPI Registered Nurse · Weyauwega, WI
NPI 1346755352 · NPPES record last updated Dec 13, 2017
Key facts
- NPI
- 1346755352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 96843-30 (WI)
- Practice address
- E5819 Hillside Dr
Weyauwega, WI 54983-9503 - Phone
- (920) 867-4565
- NPI assigned
- Dec 13, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96843-30 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 96843-30 | WI | Yes |
Addresses
Primary practice location
E5819 Hillside Dr
Weyauwega, WI 54983-9503
Mailing address
E5819 Hillside Dr
Weyauwega, WI 54983-9503
Other providers in Weyauwega, WI
- Northwest Journey - Waupaca County
- Hope Marie Oshefsky
- Deann Marie Paprocki
- Mirissa Lee Roemer
- Tammi Ann Schellin
- William J. Twohig
- Jena Vonfeldt
- Waupaca Area Ambulance, LTD.
- Cynthia May Wendt
- Weyauwega-Fremont School District
All providers in Weyauwega, WI · Registered Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.