MEDICARE: SHANEECE EARLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1962237354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANEECE EARLE

Provider Business Mailing Address
First Line	:	200 S 21ST ST STE 400A
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-1044
Country	:	US
Telephone Number	:	203-969-5984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N 163RD PLZ # STUDIOL
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2164
Country	:	US
Telephone Number	:	203-969-5984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/06/2024

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Directions to “ SHANEECE EARLE ” Practice Location

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