Ethan T Shaver, PA
Physician Assistant in Green Bay, WI. Individual provider (NPI-1).
NPI number1013452002
StatusActive
Last updated in NPPESMay 19, 2026
Details
- NPI
- 1013452002
- Entity type
- Individual (NPI-1)
- Name
- Ethan T Shaver
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 29, 2016
- Certification date
- May 19, 2026
- Last updated
- May 19, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | WI | Yes |
Practice location
1110 Kepler DrGreen Bay, WI 54311-8306
Phone 920-288-5555 · Fax 920-288-5550
Mailing address
1035 Kepler DrGreen Bay, WI 54311-8320
Phone 920-490-9046 · Fax 920-405-8005
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