Healthcare Provider Details

I. General information

NPI: 1144035973
Provider Name (Legal Business Name): SHANE BUCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NORMAL BLVD
LINCOLN NE
68506-5261
US

IV. Provider business mailing address

4820 GREENWOOD ST
LINCOLN NE
68504-2136
US

V. Phone/Fax

Practice location:
  • Phone: 402-435-1122
  • Fax: 402-435-4854
Mailing address:
  • Phone: 308-340-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number93119
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: