Healthcare Provider Details

I. General information

NPI: 1932625647
Provider Name (Legal Business Name): EMILEE LAUREN O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 F ST
GENEVA NE
68361-2229
US

IV. Provider business mailing address

1705 G ST
GENEVA NE
68361-2222
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-3192
  • Fax: 402-759-3186
Mailing address:
  • Phone: 402-768-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1712
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1805
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: