Healthcare Provider Details

I. General information

NPI: 1407644370
Provider Name (Legal Business Name): STEPHANIE R DASHIELL RD, LMNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8552 CASS ST
OMAHA NE
68114-3567
US

IV. Provider business mailing address

PO BOX 24607
OMAHA NE
68124-0607
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-6799
  • Fax: 402-955-6445
Mailing address:
  • Phone: 402-955-5400
  • Fax: 402-955-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1734
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1734
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: