Allen-Gryzwa, Shannon Pheadra
Allen-Gryzwa, Shannon Pheadra is an individual health care provider with primary practice located at Premise Healthcare Miller Health & Fitness 4400 W. State St., Milwaukee WI 53208. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Allen-Gryzwa, Shannon Pheadra can be contacted via phone (262) 928-1900.Contact Information
Primary practice address
Premise Healthcare Miller Health & Fitness 4400 W. State St.
Milwaukee WI 53208
Phone: (262) 928-1900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 40073 | Wisconsin |
Profile Details
| NPI number | 1306819479 |
|---|---|
| LBN Legal business name | Allen-Gryzwa, Shannon Pheadra |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 9th, 2006 |
| Last updated | Feb 16th, 2024 - about 9 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306819479 | NPPES |
| Wisconsin | MEDICAID | 32639500 |
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