MEDICARE: SARAH SHAHWAN APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	18101-33	WI

General Provider Information

NPI Number	:	1033064522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SHAHWAN APNP

Provider Business Mailing Address
First Line	:	2741 W LAYTON AVE STE 102
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53221-2600
Country	:	US
Telephone Number	:	414-672-8050
Fax Number	:	414-672-1050

Provider Business Practice Location Address
First Line	:	2741 W LAYTON AVE STE 102
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53221-2600
Country	:	US
Telephone Number	:	414-672-8050
Fax Number	:	414-672-1050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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