Healthcare Provider Details

I. General information

NPI: 1760244495
Provider Name (Legal Business Name): SHANICE L BAQUET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 N TEUTONIA AVE UNIT B
MILWAUKEE WI
53206-2661
US

IV. Provider business mailing address

2656 N TEUTONIA AVE UNIT 6566
MILWAUKEE WI
53206-3421
US

V. Phone/Fax

Practice location:
  • Phone: 262-457-9815
  • Fax:
Mailing address:
  • Phone: 262-457-9815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberLEHP1314
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: