Provider Demographics
NPI:1548066624
Name:THOMAS, SHELLY RAE
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAE
Last Name:THOMAS
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 1:1606 GRANDVIEW AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5822
Mailing Address - Country:US
Mailing Address - Phone:402-320-2373
Mailing Address - Fax:
Practice Address - Street 1:4433 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4275
Practice Address - Country:US
Practice Address - Phone:402-320-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion