Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7131-33 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 7131-33 | WI |
NPI | 1073056909 |
---|---|
Provider Name | Shannon Walowski |
First Address | Wauwatosa, WI 53226-3754 |
Second Address | Wauwatosa, WI 53226-3754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2016 |
Last Update Date | 17/03/2018 |