Individual
GLENACE B SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2901 86TH ST, URBANDALE, IA 50322-4201
(515) 276-3406
(515) 276-5141
Mailing address
2901 86TH ST, URBANDALE, IA 50322-4201
(515) 276-3406
(515) 276-5141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3154
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386796530
—
IA
01
—
38212
WELLMARK BLUE CROSS
IA
05
—
9163907
—
IA
01
—
P00267880
RAILROAD MEDICARE
—
Enumeration date
01/17/2007
Last updated
08/09/2012
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