Provider Demographics
NPI:1124039110
Name:SHUKERT, AVEVA HAHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AVEVA
Middle Name:HAHN
Last Name:SHUKERT
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 1:11414 W CENTER RD
Mailing Address - Street 2:SUITE 243
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-333-8210
Mailing Address - Fax:402-333-2298
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:SUITE 243
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-333-8210
Practice Address - Fax:402-333-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NER29842Medicare UPIN
NE089284Medicare ID - Type Unspecified