Provider Demographics
NPI:1053123281
Name:KROULEK, SHANA LYNN
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNN
Last Name:KROULEK
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 1:4610 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1404
Mailing Address - Country:US
Mailing Address - Phone:402-516-4715
Mailing Address - Fax:
Practice Address - Street 1:4610 S 32ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1404
Practice Address - Country:US
Practice Address - Phone:402-516-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care