Healthcare Provider Details

I. General information

NPI: 1952236770
Provider Name (Legal Business Name): ANDREA AZCUNAGA ARDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 13TH ST
COLUMBUS NE
68601-4917
US

IV. Provider business mailing address

PO BOX 1392
NORFOLK NE
68702-1392
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-0220
  • Fax: 402-644-4593
Mailing address:
  • Phone: 402-371-0220
  • Fax: 402-644-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2437
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: