Provider Demographics
NPI:1538053509
Name:FISHER, SHANNAN K (CNA, CMA)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:K
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNA, CMA
Other - Prefix:
Other - First Name:SHANNAN
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2303 ROAD B
Mailing Address - Street 2:
Mailing Address - City:POLK
Mailing Address - State:NE
Mailing Address - Zip Code:68654-2012
Mailing Address - Country:US
Mailing Address - Phone:402-366-9544
Mailing Address - Fax:
Practice Address - Street 1:2208 N WEBB RD UNIT 4
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1756
Practice Address - Country:US
Practice Address - Phone:308-381-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106727376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide