Provider Demographics
NPI:1053040196
Name:SHIMEK-LANGRUD, NICOLE MAYBELLE (EDS)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MAYBELLE
Last Name:SHIMEK-LANGRUD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2706
Mailing Address - Country:US
Mailing Address - Phone:308-293-4377
Mailing Address - Fax:
Practice Address - Street 1:2411 W 35TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2706
Practice Address - Country:US
Practice Address - Phone:308-293-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20220003523103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool