Healthcare Provider Details

I. General information

NPI: 1255642054
Provider Name (Legal Business Name): CARRIE COUFAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-9802
US

IV. Provider business mailing address

450 E 23RD ST
FREMONT NE
68025-9802
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-1610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License NumberXXXXXXX
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: