Healthcare Provider Details

I. General information

NPI: 1255908166
Provider Name (Legal Business Name): LAURA VANNORDSTRAND PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 S 39TH ST STE 300
BELLEVUE NE
68123-5206
US

IV. Provider business mailing address

124 S 24TH ST STE 230
OMAHA NE
68102-1226
US

V. Phone/Fax

Practice location:
  • Phone: 402-292-9105
  • Fax:
Mailing address:
  • Phone: 402-978-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11702
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: