Provider Demographics
NPI:1104078203
Name:BROWN, SHEWANNA A (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHEWANNA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 BISCAYNE AVE
Mailing Address - Street 2:1
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5561
Mailing Address - Country:US
Mailing Address - Phone:262-497-6548
Mailing Address - Fax:
Practice Address - Street 1:1020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1308
Practice Address - Country:US
Practice Address - Phone:414-277-8900
Practice Address - Fax:414-765-0867
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2008007199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104078203Medicaid