Individual
SHANE T GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, SRNA
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(717) 531-6597
Mailing address
201 STATE ST, ERIE, PA 16550-0001
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN706314
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN706314
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN706314
PA RN LICENSE
PA
Enumeration date
07/05/2021
Last updated
10/09/2023
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