Healthcare Provider Details

I. General information

NPI: 1265118418
Provider Name (Legal Business Name): GAGE SHRIVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MILITARY AVE STE 220
FREMONT NE
68025-5433
US

IV. Provider business mailing address

1900 E MILITARY AVE STE 220
FREMONT NE
68025-5433
US

V. Phone/Fax

Practice location:
  • Phone: 531-666-0250
  • Fax:
Mailing address:
  • Phone: 531-666-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: