Provider Demographics
NPI:1164211447
Name:GOODMAN-SHOEMAKER, RACHELE RENE
Entity type:Individual
Prefix:
First Name:RACHELE
Middle Name:RENE
Last Name:GOODMAN-SHOEMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11102 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1515
Mailing Address - Country:US
Mailing Address - Phone:402-980-8308
Mailing Address - Fax:
Practice Address - Street 1:11102 POTTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-1515
Practice Address - Country:US
Practice Address - Phone:402-980-8308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 174200000X, 3747P1801X, 385H00000X, 253Z00000X
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care