Healthcare Provider Details

I. General information

NPI: 1225838246
Provider Name (Legal Business Name): MIKISHA SHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 DODGE ST STE 100
OMAHA NE
68131-3218
US

IV. Provider business mailing address

3610 DODGE ST STE 100
OMAHA NE
68131-3218
US

V. Phone/Fax

Practice location:
  • Phone: 531-777-8621
  • Fax:
Mailing address:
  • Phone: 531-777-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: