| |
12809 W Dodge Rd, Omaha, NE 68154-2155 | |
(402) 398-6255 | |
(402) 829-8513 |
Full Name | |
---|---|
Type | Facility |
Speciality | Nurse Practitioner |
Location | 12809 W Dodge Rd, Omaha, Nebraska |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1982773776 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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12809 W Dodge Rd, Omaha, NE 68154-2155 Ph: (402) 398-6255 | 12809 W Dodge Rd, Omaha, NE 68154-2155 Ph: (402) 398-6255 |