Healthcare Provider Details

I. General information

NPI: 1366374043
Provider Name (Legal Business Name): MRS. DANIELLE SHORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E 14TH ST STE 240
HASTINGS NE
68901-3239
US

IV. Provider business mailing address

509 N KEARNEY AVE
HARVARD NE
68944-9704
US

V. Phone/Fax

Practice location:
  • Phone: 402-303-6725
  • Fax:
Mailing address:
  • Phone: 402-469-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: