Provider Demographics
NPI:1881018273
Name:REICKS, SHIRLEY J (LPN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:REICKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4164
Mailing Address - Country:US
Mailing Address - Phone:402-564-6622
Mailing Address - Fax:402-562-7239
Practice Address - Street 1:3602 16TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4164
Practice Address - Country:US
Practice Address - Phone:402-564-6622
Practice Address - Fax:402-562-7239
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE01171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$01Medicaid