Healthcare Provider Details

I. General information

NPI: 1639976574
Provider Name (Legal Business Name): LISA MARIE HOHERTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 GALVIN RD N
BELLEVUE NE
68005-4673
US

IV. Provider business mailing address

712 KOUNTZE MEMORIAL DR
BELLEVUE NE
68005-2529
US

V. Phone/Fax

Practice location:
  • Phone: 402-731-1315
  • Fax:
Mailing address:
  • Phone: 402-672-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: