Provider Demographics
NPI:1063197085
Name:FISHER, SHELBY NICHOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:NICHOLE
Last Name:FISHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6635
Mailing Address - Country:US
Mailing Address - Phone:303-550-7201
Mailing Address - Fax:
Practice Address - Street 1:137 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2017
Practice Address - Country:US
Practice Address - Phone:402-643-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty