Healthcare Provider Details

I. General information

NPI: 1316397201
Provider Name (Legal Business Name): OWEN WILLIAM NEESEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 38TH ST
COLUMBUS NE
68601-1664
US

IV. Provider business mailing address

5206 42ND STREET
COLUMBUS NE
68601-4432
US

V. Phone/Fax

Practice location:
  • Phone: 402-564-7118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101365
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: