Provider Demographics
NPI:1962237354
Name:EARLE, SHANEECE
Entity type:Individual
Prefix:
First Name:SHANEECE
Middle Name:
Last Name:EARLE
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 1:200 S 21ST ST STE 400A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1044
Mailing Address - Country:US
Mailing Address - Phone:203-969-5984
Mailing Address - Fax:
Practice Address - Street 1:3620 N 163RD PLZ # STUDIOL
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2164
Practice Address - Country:US
Practice Address - Phone:203-969-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management