Provider Demographics
NPI:1053118786
Name:WICKS, SHELLY ANN
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:WICKS
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 1:260 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68354-9609
Mailing Address - Country:US
Mailing Address - Phone:402-759-1918
Mailing Address - Fax:
Practice Address - Street 1:2610 W M CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1006
Practice Address - Country:US
Practice Address - Phone:402-325-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty