Healthcare Provider Details

I. General information

NPI: 1003413436
Provider Name (Legal Business Name): LUPE ACOSTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SOUTH 3RD STREET
HOMER NE
68030
US

IV. Provider business mailing address

212 SOUTH 3RD STREET
HOMER NE
68030
US

V. Phone/Fax

Practice location:
  • Phone: 402-698-2377
  • Fax:
Mailing address:
  • Phone: 402-698-2377
  • Fax: 402-698-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number155572
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: