Provider Demographics
NPI:1639639701
Name:HERSHISER, SHIRLETTE A (RDH)
Entity Type:Individual
Prefix:MS
First Name:SHIRLETTE
Middle Name:A
Last Name:HERSHISER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LUCILE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6032
Mailing Address - Country:US
Mailing Address - Phone:402-483-7631
Mailing Address - Fax:
Practice Address - Street 1:4200 LUCILE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6028
Practice Address - Country:US
Practice Address - Phone:402-483-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1419124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1419OtherDENTAL HYGIENE LICENSE