Healthcare Provider Details

I. General information

NPI: 1912489360
Provider Name (Legal Business Name): SHOUA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHOUA VUE FNP

II. Dates (important events)

Enumeration Date: 09/02/2018
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 UNION AVE
SHEBOYGAN WI
53081-8426
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-802-2100
  • Fax:
Mailing address:
  • Phone: 920-802-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14533-033
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: