Provider Demographics
NPI:1922508837
Name:ANDERSON, SHANA DEE
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:DEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHANA
Other - Middle Name:DEE
Other - Last Name:ANDERSON GREER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-1008
Mailing Address - Country:US
Mailing Address - Phone:254-747-2391
Mailing Address - Fax:
Practice Address - Street 1:1223 E TITUS ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3042
Practice Address - Country:US
Practice Address - Phone:254-747-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX823584163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse