Healthcare Provider Details

I. General information

NPI: 1235568643
Provider Name (Legal Business Name): CONNIE LOSEKE LPN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 26TH ST
CENTRAL CITY NE
68826-9501
US

IV. Provider business mailing address

1715 26TH ST
CENTRAL CITY NE
68826-9501
US

V. Phone/Fax

Practice location:
  • Phone: 308-946-3015
  • Fax:
Mailing address:
  • Phone: 308-946-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5638
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: