Provider Demographics
NPI:1841097961
Name:HAYES, SHANNON DIANE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DIANE
Last Name:HAYES
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 1:261 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3025
Mailing Address - Country:US
Mailing Address - Phone:402-968-0077
Mailing Address - Fax:
Practice Address - Street 1:11340 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3815
Practice Address - Country:US
Practice Address - Phone:402-444-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44862373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist