MEDICARE: SHAUNA K RICHARDSON 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	363LW0102X	Women's Health Nurse Practitioner	130336	WI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5813-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447206511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNA K RICHARDSON APNP

Provider Business Mailing Address
First Line	:	1010 35TH ST
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53140-1902
Country	:	US
Telephone Number	:	262-725-4426
Fax Number	:	262-299-7136

Provider Business Practice Location Address
First Line	:	1010 35TH ST
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53140-1902
Country	:	US
Telephone Number	:	262-725-4426
Fax Number	:	262-299-7136

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/17/2025

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