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Individual

SHANNON J KORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4130 PIONEER WOODS DR STE 1, LINCOLN, NE 68506-7552
(402) 489-4700
(402) 489-5220
Mailing address
4130 PIONEER WOODS DR STE 1, LINCOLN, NE 68506-7552
(402) 489-4700
(402) 489-5220

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2250
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2250
MEDICAL LICENSE
NE
Enumeration date
06/14/2018
Last updated
06/14/2018
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