Fogarty, Shannon M

Fogarty, Shannon M is an individual health care provider with primary practice located at 1055 N Mayfair Rd , Wauwatosa WI 53226. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Fogarty, Shannon M can be contacted via phone (414) 479-2300.

Contact Information

Primary practice address
1055 N Mayfair Rd Wauwatosa WI 53226
Phone: (414) 479-2300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 1545-033 Wisconsin

Profile Details

NPI number 1508801622
LBN Legal business name Fogarty, Shannon M
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2006
Last updated Nov 18th, 2021 - about 3 years 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508801622 NPPES
Wisconsin Other 500014946 MEDICARE RAILROAD
Wisconsin MEDICAID 43917700 MEDICARE RAILROAD

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