Basic Information
| Provider Information | |||||||||
| NPI: | 1477689883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEEN | ||||||||
| FirstName: | TABITHA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 15TH AVE. | ||||||||
| Address2: | STE. 180, LAKESHORE MEDICAL CLINIC | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147685430 | ||||||||
| FaxNumber: | 4147624224 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 E. LAYTON AVE. | ||||||||
| Address2: | LAKESHORE MEDICAL CLINIC | ||||||||
| City: | ST. FRANCIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532356053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147446589 | ||||||||
| FaxNumber: | 4147478848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 108285-30 | WI | N | Nursing Service Providers | Registered Nurse | 363L00000X | 2803 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.