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General NPI Number Information
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NPI Number | 1407635774
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Entity Type | Individual
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Provider Name | SHANNON GREENE R. EEG T., CLTM
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Gender | Female
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 1819 JAY ELL DR
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City | RICHARDSON
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State | TX
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Zip | 75081-2063
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Country | US
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Telephone | 888-344-2947
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Fax |
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Provider Business Mailing Address
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Address Line | 11206 UNIVERSITY AVE APT 204
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City | LUBBOCK
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State | TX
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Zip | 79423-6194
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Country | US
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Telephone | 612-570-4675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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