Shannon L Soderberg, APRN-NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

114272 Issued in NE

Practice address

1000 N 90TH St Ste 200
Omaha, NE 68114-2766

Phone

(402) 955-3900

Fax

(402) 955-3920

NPI assigned

Jul 11, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Regional West Physicians Clinic

  • Family Medicine Physician
  • Scottsbluff, NE
  • NPI 1306910534
  Medicare reassignment NPD
• Children's Specialty Physician Billing - Behavioral Health

  • Psychologist
  • Omaha, NE
  • NPI 1124152996
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1194459875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24607",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681240607",
            "telephone_number": "402-955-5400",
            "fax_number": "402-955-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N 90TH ST STE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142766",
            "telephone_number": "402-955-3900",
            "fax_number": "402-955-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERBERG",
        "first_name": "SHANNON",
        "middle_name": "L",
        "credential": "APRN-NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-11",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NE",
            "license": "114272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yusuf Sodal
• Andrew Sodawasser
• Daniel John Soden, PSYD
• Garbielle Soden
• Elizabeth Alice Soderberg
• Domerlin Sodusta
• Aye Soe
• Eh Soe
• Gre Soe
• Hser Ry Soe

• Psychiatric/Mental Health Nurse Practitioner in Omaha, NE
• Providers in Omaha, NE by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.