Provider Demographics
NPI:1235292400
Name:SHOCKLEY, WILLIAM HARVEY III (RN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARVEY
Last Name:SHOCKLEY
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 406
Mailing Address - Street 2:W4002 OAKVIEW RD
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487
Mailing Address - Country:US
Mailing Address - Phone:715-453-8684
Mailing Address - Fax:
Practice Address - Street 1:309 MARY ANN AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2417
Practice Address - Country:US
Practice Address - Phone:715-341-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI076997163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice