Healthcare Provider Details

I. General information

NPI: 1508858291
Provider Name (Legal Business Name): NYE SQUARE LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 23RD ST
FREMONT NE
68025-2595
US

IV. Provider business mailing address

655 W 23RD ST
FREMONT NE
68025-2595
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-9224
  • Fax: 402-753-6133
Mailing address:
  • Phone: 402-721-9224
  • Fax: 402-753-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNE

VIII. Authorized Official

Name: MRS. JUDY HELLMERS
Title or Position: BOOKKEEPER
Credential:
Phone: 402-753-6122