Healthcare Provider Details

I. General information

NPI: 1851106850
Provider Name (Legal Business Name): CAROLE JEAN FISTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 282 720 CHEYENNE AVE
HEMINGFORD NE
69348
US

IV. Provider business mailing address

BOX 282 720 CHEYENNE AVE
HEMINGFORD NE
69348
US

V. Phone/Fax

Practice location:
  • Phone: 308-760-5867
  • Fax:
Mailing address:
  • Phone: 308-760-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: