Individual
SHANNON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8201 S 61ST ST, LINCOLN, NE 68516-5994
(931) 217-6445
Mailing address
8201 S 61ST ST, LINCOLN, NE 68516-5994
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
78226
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
78226
REGISTERRED NURSE LICENSE NUMBER
NE
Enumeration date
05/03/2018
Last updated
05/03/2018
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