Healthcare Provider Details

I. General information

NPI: 1679673883
Provider Name (Legal Business Name): DEBRA JEAN CARLSON RP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E 23RD ST
FREMONT NE
68025-2445
US

IV. Provider business mailing address

8962 COUNTY ROAD 3
NICKERSON NE
68044-2511
US

V. Phone/Fax

Practice location:
  • Phone: 402-753-2460
  • Fax:
Mailing address:
  • Phone: 308-360-2817
  • Fax: 402-478-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8975
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: