Provider Demographics
NPI:1093290041
Name:SHANK, CHRISTINE ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:SHANK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 OAKS HOLW
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3752
Mailing Address - Country:US
Mailing Address - Phone:402-318-2131
Mailing Address - Fax:
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-327-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE112633OtherAPRN-NURSE PRACTIONER LICENSE