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NPI Code Detail

MEDICARE: MRS. NANCY JO ENGQUIST L.C.S.W.

MEDICARE: MRS. NANCY JO ENGQUIST L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1144NE

General Provider Information

NPI Number : 1699870071
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NANCY JO ENGQUIST L.C.S.W.
Provider Business Mailing Address
First Line : 818 S 113TH AVENUE CIR
Second Line :
City : OMAHA
State : NE
Zip : 68154-1561
Country : US
Telephone Number : 402-697-5163
Fax Number :
Provider Business Practice Location Address
First Line : 4001 LEAVENWORTH ST
Second Line :
City : OMAHA
State : NE
Zip : 68105-1026
Country : US
Telephone Number : 402-341-5128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 02/25/2014

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