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General NPI Number Information
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NPI Number | 1477689883
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Entity Type | Individual
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Provider Name | TABITHA M. SHEEN APNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 2000 E. LAYTON AVE. LAKESHORE MEDICAL CLINIC
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City | ST. FRANCIS
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State | WI
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Zip | 53235-6053
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Country | US
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Telephone | 414-744-6589
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Fax | 414-747-8848
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Provider Business Mailing Address
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Address Line | 100 15TH AVE. STE. 180, LAKESHORE MEDICAL CLINIC
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-1160
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Country | US
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Telephone | 414-768-5430
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Fax | 414-762-4224
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 108285-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2803
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License Number State | WI
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