Individual
SHANE GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 992-0323
Mailing address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 992-0323
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
23-41218-032
KS
Other
Enumeration date
09/22/2011
Last updated
09/22/2011
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