Provider Demographics
NPI:1265932339
Name:GILLMING, SHANNA (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:
Last Name:GILLMING
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-0102
Mailing Address - Country:US
Mailing Address - Phone:308-698-8080
Mailing Address - Fax:
Practice Address - Street 1:2702 W 11TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-0102
Practice Address - Country:US
Practice Address - Phone:308-698-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse