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MS. SHANNON LOFTIS PAC

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1972557221

Individual Registrant:
MS. SHANNON  LOFTIS PAC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1155 N MAYFAIR RD PLANK ROAD CLINIC MILWAUKEE, WI 53226-3421 US
Tel: 414-955-5990  Fax: 414-955-6282

Contact information for business:
1155 N MAYFAIR RD PLANK ROAD CLINIC MILWAUKEE, WI 53226-3421 US
Tel: 414-955-5990  Fax: 414-955-6282

Registration Information:
NPI: 1972557221
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
WI928-023

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1972557221WI05
HUMANA008000315Q01




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