Healthcare Provider Details

I. General information

NPI: 1881842003
Provider Name (Legal Business Name): CHRISTINE PFEIFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

IV. Provider business mailing address

4140 NORWOOD DR
GRAND ISLAND NE
68803-3125
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-3660
  • Fax: 308-389-5112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number3350
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: