Healthcare Provider Details

I. General information

NPI: 1467067264
Provider Name (Legal Business Name): CHANDRA RUTH PHELPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 13TH ST STE 110
AURORA NE
68818-2426
US

IV. Provider business mailing address

616 13TH ST STE 110
AURORA NE
68818-2426
US

V. Phone/Fax

Practice location:
  • Phone: 402-631-7267
  • Fax:
Mailing address:
  • Phone: 402-631-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number80718
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number80718
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number80718
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number80718
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number80718
License Number StateNE
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80718
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: