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General NPI Number Information
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NPI Number | 1255148656
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Entity Type | Individual
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Provider Name | MARY GRACE SHANABARGER APNP, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 788 N JEFFERSON ST STE 300
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City | MILWAUKEE
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State | WI
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Zip | 53202-3710
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Country | US
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Telephone | 414-272-8950
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Fax |
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Provider Business Mailing Address
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Address Line | N16W24131 RIVERWOOD DR
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City | WAUKESHA
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State | WI
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Zip | 53188-1106
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Country | US
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Telephone | 262-696-0808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 256531-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 16303-33
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 16303
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License Number State | WI
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