Provider Demographics
NPI:1447068358
Name:MORGAN, SHANICE LEE'ANN
Entity type:Individual
Prefix:MRS
First Name:SHANICE
Middle Name:LEE'ANN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANICE
Other - Middle Name:LEE'ANN
Other - Last Name:BRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11220 BLONDO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3820
Mailing Address - Country:US
Mailing Address - Phone:531-299-1660
Mailing Address - Fax:
Practice Address - Street 1:11220 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3820
Practice Address - Country:US
Practice Address - Phone:531-299-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant