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General NPI Number Information
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NPI Number | 1932637444
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Entity Type | Individual
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Provider Name | KATRINA MARIE SHAY APNP
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Gender | Female
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Dates
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Enumeration Date | 05/28/2017
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-9728
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Fax | 414-805-6808
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Provider Business Mailing Address
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Address Line | 4909 W TUMBLE CREEK DR
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City | FRANKLIN
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State | WI
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Zip | 53132-8392
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Country | US
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Telephone | 920-517-0717
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Fax | 414-805-6808
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 769133
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License Number State | WI
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