Individual
SHANE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
314 GROVE NECK RD, EARLEVILLE, MD 21919-3008
(410) 275-6200
Mailing address
109 E REDDING ST, MIDDLETOWN, DE 19709-1432
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L2-0013073
DE
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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