Healthcare Provider Details

I. General information

NPI: 1639004559
Provider Name (Legal Business Name): LACI SHEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4667 O ST
OMAHA NE
68117-2141
US

IV. Provider business mailing address

502 CHATEAU DR APT A
BELLEVUE NE
68005-2112
US

V. Phone/Fax

Practice location:
  • Phone: 402-672-4544
  • Fax:
Mailing address:
  • Phone: 402-672-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: