| Doctor Name: | LEESA ANN MCSHANE |
| NPI Number: | 1629302187 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A.P.N.P. |
| License Number: | 3836-033 |
| Business Practice Address: | 670 County Road A Green Lake, WI - 549418608 |
| Business Phone Number: | 9202940100 |
| Business Fax Number: | 9202940123 |
| Mailing Address: | 888 Thackeray Trl 103, OCONOMOWOC |
| State: | WI |
| Postal Code: | 530664342 |
| Phone Number: | 2623543744 |
| Fax Number: | 2623543748 |
| NPI Enumeration Date: | 09/30/2009 |
| NPI Last Update Date: | 12/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3836-033 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |