Individual ProviderCathy Diane ShineNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1305 W. American Drive, Neenah, WI 54956-2883(920) 725-9373PECOS EnrollmentBased on the most recent information from CMS, provider Cathy Diane Shine does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1710938899Provider TypeIndividualFull NameShine, Cathy DianeCredentialNPGenderFemaleSole ProprietorYesEnumeration Date5/13/2006Last Updated12/19/2011Contact InformationPractice LocationPractice Address1305 W. American Drive, Neenah, WI 54956-2883Phone(920) 725-9373Fax(920) 720-7392Mailing LocationMailing Address1305 W. American Drive, Neenah, WI 54956-2883Phone(920) 725-9373Fax(920) 720-7392Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense2005007423WisconsinProvider IdentifiersIDDescriptionIssuerID41278400DescriptionMedicaidIssuerUnlistedWisconsinID005A71450DescriptionOtherIssuerMEDICAIDWisconsin