Healthcare Provider Details

I. General information

NPI: 1518326412
Provider Name (Legal Business Name): CATRINA HEATH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATRINA SHOOKMAN

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SAVANNAH DR
DEFOREST WI
53532-2909
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-3300
  • Fax:
Mailing address:
  • Phone: 608-417-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6838-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: