Provider Demographics
NPI:1255138608
Name:OLIVER, STEPHAINE SHONREKIA
Entity type:Individual
Prefix:
First Name:STEPHAINE
Middle Name:SHONREKIA
Last Name:OLIVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 N 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-2607
Mailing Address - Country:US
Mailing Address - Phone:531-239-9375
Mailing Address - Fax:
Practice Address - Street 1:5235 N 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-2607
Practice Address - Country:US
Practice Address - Phone:531-239-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide