Provider Demographics
NPI:1194147405
Name:SHOOK, RENIECE (RN)
Entity type:Individual
Prefix:
First Name:RENIECE
Middle Name:
Last Name:SHOOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10406 W GREENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67215-1655
Mailing Address - Country:US
Mailing Address - Phone:316-644-8120
Mailing Address - Fax:
Practice Address - Street 1:10406 W GREENFIELD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67215-1655
Practice Address - Country:US
Practice Address - Phone:316-644-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-115159-102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse