Healthcare Provider Details

I. General information

NPI: 1447740642
Provider Name (Legal Business Name): RACHEL S GLIDDEN APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL S DURHAM

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 41ST AVE
COLUMBUS NE
68601-2131
US

IV. Provider business mailing address

4321 41ST AVE
COLUMBUS NE
68601-2131
US

V. Phone/Fax

Practice location:
  • Phone: 402-562-7500
  • Fax: 402-564-0611
Mailing address:
  • Phone: 402-562-7500
  • Fax: 402-564-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78190
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112519
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: