Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 31836 | NE |
NPI | 1275977654 |
---|---|
Provider Name | Jessica Barbara Shank |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 21/06/2019 |