Healthcare Provider Details

I. General information

NPI: 1508750134
Provider Name (Legal Business Name): MICHELLE RUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN HASWELL

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 N CLARKSON ST
FREMONT NE
68025-2626
US

IV. Provider business mailing address

2106 N CLARKSON ST
FREMONT NE
68025-2626
US

V. Phone/Fax

Practice location:
  • Phone: 402-719-2398
  • Fax:
Mailing address:
  • Phone: 402-719-2398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: