Provider Demographics
NPI:1407635774
Name:GREENE, SHANNON (R EEG T, CLTM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:R EEG T, CLTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11206 UNIVERSITY AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6194
Mailing Address - Country:US
Mailing Address - Phone:612-570-4675
Mailing Address - Fax:
Practice Address - Street 1:1819 JAY ELL DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2063
Practice Address - Country:US
Practice Address - Phone:888-344-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic