Healthcare Provider Details

I. General information

NPI: 1386274520
Provider Name (Legal Business Name): SHAWNA MARIE GARITO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 06/03/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S 40TH ST SUITE 102
LINCOLN NE
68506-2425
US

IV. Provider business mailing address

2200 S 40TH ST SUITE 102
LINCOLN NE
68506-2425
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-0717
  • Fax: 402-951-9763
Mailing address:
  • Phone: 402-413-0717
  • Fax: 402-951-9763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberAPRN11004543
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114134
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114134
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: