Healthcare Provider Details

I. General information

NPI: 1558283622
Provider Name (Legal Business Name): SHANNON DAWN DICKMEYER X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 WALKER AVE
LINCOLN NE
68507-2368
US

IV. Provider business mailing address

5640 WALKER AVE
LINCOLN NE
68507-2368
US

V. Phone/Fax

Practice location:
  • Phone: 402-770-4121
  • Fax: 402-770-4121
Mailing address:
  • Phone: 402-770-4121
  • Fax: 402-770-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNONE
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: