Provider Demographics
NPI:1265855803
Name:GREENE, SHAWNA NICOLE (DVM, MS, DIPL AEVIM)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:NICOLE
Last Name:GREENE
Suffix:
Gender:F
Credentials:DVM, MS, DIPL AEVIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W. GALENA BLVD.
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-896-8541
Mailing Address - Fax:631-301-6134
Practice Address - Street 1:2600 W. GALENA BLVD.
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-896-8541
Practice Address - Fax:631-301-6134
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090.009694174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian