Provider Demographics
NPI:1063128221
Name:SKOWRON, SHANNON (APNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SKOWRON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W225N16711 CEDAR PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9222
Mailing Address - Country:US
Mailing Address - Phone:262-677-1101
Mailing Address - Fax:
Practice Address - Street 1:W225 N16711 CEDAR PARK CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9222
Practice Address - Country:US
Practice Address - Phone:262-677-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily