Individual
MRS. SHANNON MCCORKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 W 7TH ST, MC COOK, NE 69001-3079
(308) 345-2510
Mailing address
700 W 7TH ST, MC COOK, NE 69001-3079
(308) 345-2510
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
143016
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6875358463
NE STATE STAFF ID
NE
Enumeration date
10/06/2022
Last updated
10/06/2022
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