Healthcare Provider Details

I. General information

NPI: 1134621790
Provider Name (Legal Business Name): DEBRA IMHOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 KAYLEEN DR
BELLEVUE NE
68005-2342
US

IV. Provider business mailing address

701 KAYLEEN DR
BELLEVUE NE
68005-2342
US

V. Phone/Fax

Practice location:
  • Phone: 402-293-4370
  • Fax:
Mailing address:
  • Phone: 402-293-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number50048
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: