Healthcare Provider Details

I. General information

NPI: 1134502529
Provider Name (Legal Business Name): DIANE M ALDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47474 877TH RD
ATKINSON NE
68713-4842
US

IV. Provider business mailing address

47474 877TH RD
ATKINSON NE
68713-4842
US

V. Phone/Fax

Practice location:
  • Phone: 402-340-5718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number746
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number746
License Number StateNE

VIII. Authorized Official

Name: DIANE M ALDEN
Title or Position: REGISTERED DENTAL HYGIENIST
Credential:
Phone: 402-340-5718