MEDICARE: ANGELA M SHENGENA CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	8505	MN

General Provider Information

NPI Number	:	1215606124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA M SHENGENA CNP

Provider Business Mailing Address
First Line	:	34700 VALLEY RD
Second Line	:
City	:	OCONOMOWOC
State	:	WI
Zip	:	53066-4500
Country	:	US
Telephone Number	:	262-646-4411
Fax Number	:	262-646-1049

Provider Business Practice Location Address
First Line	:	6442 CITY WEST PKWY STE 200
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2809
Country	:	US
Telephone Number	:	763-318-2800
Fax Number	:	763-318-2801

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

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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