Individual
SHANNON GROSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1430 EDUCATION DR, SYRACUSE, NE 68446-4000
(402) 269-2388
Mailing address
550 7TH STREET, -, SYRACUSE, NE 68446
(402) 269-5866
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
15980
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15980
—
NE
Enumeration date
08/11/2022
Last updated
08/11/2022
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