Provider Demographics
NPI:1124030242
Name:CONNER, SHARI MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:MARIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 FREDERICK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3061
Mailing Address - Country:US
Mailing Address - Phone:402-871-4474
Mailing Address - Fax:402-998-5260
Practice Address - Street 1:8710 FREDERICK ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3061
Practice Address - Country:US
Practice Address - Phone:402-871-4474
Practice Address - Fax:402-998-5260
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025097700Medicaid
NE260094000OtherMIS NUMBER
NE35902OtherMIDLANDS CHOICE NUMBER
NE478252OtherVALUE OPTIONS
NE08902OtherBC/BS NUMBER FOR BELLEVUE
NE10025166600Medicaid
NE35902OtherMIDLANDS CHOICE NUMBER
NE478252OtherVALUE OPTIONS
NE10025097700Medicaid
NE478252OtherVALUE OPTIONS
NEQ22484Medicare UPIN