Shannon Grosse
Individual provider Active NPI Licensed Practical Nurse · Syracuse, NE
NPI 1194453738 · NPPES record last updated Aug 11, 2022
Key facts
- NPI
- 1194453738
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 15980 (NE)
- Practice address
- 1430 Education Dr
Syracuse, NE 68446-4000 - Phone
- (402) 269-2388
- NPI assigned
- Aug 11, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15980 | NE | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| School District 27 Otoe County | Current |
Accepting new patients |
Locations
550 7th St
Syracuse, NE 68446
Phone (402) 269-2382
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 15980 | NE | Yes |
Addresses
Primary practice location
1430 Education Dr
Syracuse, NE 68446-4000
Mailing address
550 7TH Street
-
Syracuse, NE 68446
Phone (402) 269-5866
Other practice location 1
1500 Education Dr
Syracuse, NE 68446-4001
Phone (402) 269-2381
Other practice location 2
550 7th Street
-
Syracuse, NE 68446
Phone (402) 269-5866 ext. 1102
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15980 | Medicaid | NE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Powerschool |
Other providers in Syracuse, NE
- Ashley Nicole Emerson
- Amanda Marie Fass
- James Frey
- Jennifer Lee Gates
- John Patrick Giddings
- Emily Candice Iske
- Kaitlin Jacobsen
- Wesley D Janssen
- Diane Jergensen
- Noah Kasbohm
All providers in Syracuse, NE · Licensed Practical Nurse in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.