Healthcare Provider Details

I. General information

NPI: 1093290041
Provider Name (Legal Business Name): CHRISTINE ANN SHANK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 S 91ST ST
LINCOLN NE
68526-9797
US

IV. Provider business mailing address

6301 OAKS HOLW
LINCOLN NE
68516-3752
US

V. Phone/Fax

Practice location:
  • Phone: 402-327-2700
  • Fax:
Mailing address:
  • Phone: 402-318-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112633
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: