Provider Demographics
NPI:1104056985
Name:BISNETTE, SHANNA
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:BISNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N, KS-99
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:KS
Mailing Address - Zip Code:66549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 N, KS-99
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:KS
Practice Address - Zip Code:66549
Practice Address - Country:US
Practice Address - Phone:785-457-2801
Practice Address - Fax:512-310-9228
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01989225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0031DGOtherBLUE CROSS BLUE SHIELD
TX0944746-02Medicaid
74-2745294OtherTAX ID
TX0944746-02Medicaid