Healthcare Provider Details

I. General information

NPI: 1124940002
Provider Name (Legal Business Name): MOLLY ANNE SHREVES
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

3901 FAULKNER DR
LINCOLN NE
68516-4738
US

IV. Provider business mailing address

6162 BLACKSTONE RD
LINCOLN NE
68526-9538
US

V. Phone/Fax

Practice location:
  • Phone: 402-875-9270
  • Fax:
Mailing address:
  • Phone: 605-661-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number117113
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: