Healthcare Provider Details

I. General information

NPI: 1538053509
Provider Name (Legal Business Name): SHANNAN K FISHER CNA, CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNAN ROBERTS

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 N WEBB RD UNIT 4
GRAND ISLAND NE
68803-1756
US

IV. Provider business mailing address

2303 ROAD B
POLK NE
68654-2012
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-1690
  • Fax:
Mailing address:
  • Phone: 402-366-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number106727
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: