=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992645055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON LEA RAIKOWSKI RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2026
-----------------------------------------------------
Last Update Date | 03/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 HALE ST
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54495-2787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-424-4682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2831 COUNTY ROAD C
-----------------------------------------------------
City | STEVENS POINT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54481-9519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-432-2338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Registered Nurse
-----------------------------------------------------
License Number | 234174-30
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------