Provider Demographics
NPI:1689025777
Name:SHANER, HENRY (LPN)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:SHANER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S FRAN AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1252
Mailing Address - Country:US
Mailing Address - Phone:660-227-6040
Mailing Address - Fax:
Practice Address - Street 1:411 S FRAN AVE APT 8
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1252
Practice Address - Country:US
Practice Address - Phone:660-227-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO055797164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse