Provider Demographics
NPI:1588716781
Name:SHADE, DAISY SUE (PA-C)
Entity type:Individual
Prefix:MS
First Name:DAISY
Middle Name:SUE
Last Name:SHADE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8550 CUTHILLS CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9474
Mailing Address - Country:US
Mailing Address - Phone:402-476-6060
Mailing Address - Fax:402-476-6809
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 708
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1225
Practice Address - Country:US
Practice Address - Phone:402-486-3444
Practice Address - Fax:402-486-3590
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-11-12
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Provider Licenses
StateLicense IDTaxonomies
NE711363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES58870Medicare UPIN