Healthcare Provider Details

I. General information

NPI: 1356632772
Provider Name (Legal Business Name): NORTHEAST NEBRASKA FAMILY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E 22ND ST SUITE 4
FREMONT NE
68025-2661
US

IV. Provider business mailing address

230 E 22ND ST SUITE 4
FREMONT NE
68025-2661
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-5336
  • Fax: 402-727-7392
Mailing address:
  • Phone: 402-727-5336
  • Fax: 402-727-7392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberHC016
License Number StateNE

VIII. Authorized Official

Name: MS. DEBORAH SUE BUNN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 402-727-5336