Healthcare Provider Details

I. General information

NPI: 1679478697
Provider Name (Legal Business Name): MS. SHAWNA L WISHECOBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 N 148TH CT APT 3206
OMAHA NE
68116-7214
US

IV. Provider business mailing address

3128 N 60TH ST APT 3
OMAHA NE
68104-3479
US

V. Phone/Fax

Practice location:
  • Phone: 520-977-3083
  • Fax:
Mailing address:
  • Phone: 531-365-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: