Healthcare Provider Details

I. General information

NPI: 1649117359
Provider Name (Legal Business Name): ANNISSA DAWN HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 GARDEN ST
BENNET NE
68317-2429
US

IV. Provider business mailing address

740 GARDEN ST
BENNET NE
68317-2429
US

V. Phone/Fax

Practice location:
  • Phone: 402-580-0264
  • Fax:
Mailing address:
  • Phone: 402-580-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberH13542500
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: