Healthcare Provider Details

I. General information

NPI: 1063190478
Provider Name (Legal Business Name): SHANON GRACE MCLEAY APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SOUTH 42ND ST.
OMAHA NE
68131
US

IV. Provider business mailing address

985578 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5578
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-6007
  • Fax:
Mailing address:
  • Phone: 402-552-6007
  • Fax: 402-552-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114947
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number76214
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: