Healthcare Provider Details

I. General information

NPI: 1023074150
Provider Name (Legal Business Name): SHIRLEY JEAN MAAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W DAVIS ST
BEAVER DAM WI
53916-2814
US

IV. Provider business mailing address

108 W DAVIS ST
BEAVER DAM WI
53916-2814
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-8183
  • Fax:
Mailing address:
  • Phone: 920-887-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: