Healthcare Provider Details

I. General information

NPI: 1104781681
Provider Name (Legal Business Name): LYNETTE SHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 LAKE PARK LN
HASTINGS NE
68901-2583
US

IV. Provider business mailing address

3511 LAKE PARK LN
HASTINGS NE
68901-2583
US

V. Phone/Fax

Practice location:
  • Phone: 402-984-6985
  • Fax:
Mailing address:
  • Phone: 402-984-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberG14023448
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: