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NPI Code Detail

MEDICARE: KYLAH MARIE SHINE SUPIK

MEDICARE: KYLAH MARIE SHINE SUPIK
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
1372600000XAdult Companion

General Provider Information

NPI Number : 1710770235
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLAH MARIE SHINE SUPIK
Provider Business Mailing Address
First Line : 1719 S LOCUST ST
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-8248
Country : US
Telephone Number : 402-699-4902
Fax Number :
Provider Business Practice Location Address
First Line : 1719 S LOCUST ST
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-8248
Country : US
Telephone Number : 402-699-4902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2025
Last Update Date : 05/27/2025

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Directions to “ KYLAH MARIE SHINE SUPIK ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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