Provider Demographics
NPI:1174099634
Name:BADJE, SHANNA R (CRNA)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:R
Last Name:BADJE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3809 CLIFFSIDE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8337
Mailing Address - Country:US
Mailing Address - Phone:262-749-0914
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-4123
Practice Address - Country:US
Practice Address - Phone:608-263-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8923367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered