Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 3054-19 | WI |
NPI | 1013515592 |
---|---|
Provider Name | Taylor Anne Shook |
First Address | South Milwaukee, WI 53172-3712 |
Second Address | South Milwaukee, WI 53172-3712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2020 |
Last Update Date | 15/10/2020 |