Provider Demographics
NPI:1669363487
Name:HUTCHINSON, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:HUTCHINSON
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 1:14120 MANDERSON PLZ APT 304
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6297
Mailing Address - Country:US
Mailing Address - Phone:402-651-0055
Mailing Address - Fax:
Practice Address - Street 1:14750 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1402
Practice Address - Country:US
Practice Address - Phone:402-651-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide