Individual
SHAUNTA PAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4211 S 143RD CIR, OMAHA, NE 68137-4505
(402) 598-0517
Mailing address
4211 S 143RD CIR, OMAHA, NE 68137-4505
(402) 598-0517
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
H12418951
NE
Other
Enumeration date
04/16/2025
Last updated
04/16/2025
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