Provider Demographics
NPI:1851757116
Name:SHEELY, DEBORAH BOETTCHER
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:BOETTCHER
Last Name:SHEELY
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 1:8101 O ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2646
Mailing Address - Country:US
Mailing Address - Phone:402-488-1032
Mailing Address - Fax:402-484-8545
Practice Address - Street 1:8101 O ST
Practice Address - Street 2:SUITE 214
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2646
Practice Address - Country:US
Practice Address - Phone:402-488-1032
Practice Address - Fax:402-484-8545
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4700101YM0800X
NE2273101YM0800X
NE42782163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse