| Doctor Name: | SHAYNA PANKRATZ |
| NPI Number: | 1336541622 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 5979-33 |
| Business Practice Address: | 407 S Main St Suite 102 Viroqua, WI - 546652100 |
| Business Phone Number: | 6086374799 |
| Business Fax Number: | 6086386003 |
| Mailing Address: | 407 S Main St, Suite 102 VIROQUA |
| State: | WI |
| Postal Code: | 546652100 |
| Phone Number: | 6086374799 |
| Fax Number: | 6086386003 |
| NPI Enumeration Date: | 09/18/2014 |
| NPI Last Update Date: | 09/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 5979-33 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |