Healthcare Provider Details

I. General information

NPI: 1467383208
Provider Name (Legal Business Name): SHANNON MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

IV. Provider business mailing address

4016 GREENWOOD DR
GRAND ISLAND NE
68803-3116
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-3660
  • Fax:
Mailing address:
  • Phone: 308-379-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73936
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: