Healthcare Provider Details

I. General information

NPI: 1821926957
Provider Name (Legal Business Name): CONNIE C ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 GREGG RD APT 5
BELLEVUE NE
68123-4429
US

IV. Provider business mailing address

PO BOX 633
BELLEVUE NE
68005-0633
US

V. Phone/Fax

Practice location:
  • Phone: 402-889-5132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: