Provider Demographics
NPI:1588696413
Name:SCHUTTE, SHELLY M (P-AC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:M
Last Name:SCHUTTE
Suffix:
Gender:F
Credentials:P-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:7831 CHICAGO CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3654
Practice Address - Country:US
Practice Address - Phone:402-354-1230
Practice Address - Fax:402-354-1235
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE878363A00000X
IA075825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37753OtherBCBSNE
NE099459001Medicare PIN
NEP12786Medicare UPIN
NE37753OtherBCBSNE
NE099459Medicare PIN