Healthcare Provider Details

I. General information

NPI: 1689381964
Provider Name (Legal Business Name): KEELEY NOEL SHERMAN MSN, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17675 WELCH PLZ
OMAHA NE
68135-3551
US

IV. Provider business mailing address

18561 CHICAGO CT APT 206
ELKHORN NE
68022-7935
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-7600
  • Fax:
Mailing address:
  • Phone: 630-465-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number114499
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: