Healthcare Provider Details

I. General information

NPI: 1184917239
Provider Name (Legal Business Name): JANET RAE HAGERBAUMER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MILITARY AVE SUITE 236
FREMONT NE
68025-5433
US

IV. Provider business mailing address

27765 COUNTY ROAD 14
HOOPER NE
68031-5000
US

V. Phone/Fax

Practice location:
  • Phone: 402-719-4596
  • Fax:
Mailing address:
  • Phone: 402-719-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2643
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: