Healthcare Provider Details

I. General information

NPI: 1164843504
Provider Name (Legal Business Name): CHRISTINE ELLEN DOUGLAS RD, LMNT, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE ELLEN HRABAN

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S. BURG STREET KIMBALL HEALTH SERVICES AT
KIMBALL NE
69145
US

IV. Provider business mailing address

505 S. BURG STREET KIMBALL HEALTH SERVICES AT
KIMBALL NE
69145
US

V. Phone/Fax

Practice location:
  • Phone: 308-235-1966
  • Fax: 308-235-1957
Mailing address:
  • Phone: 308-235-1966
  • Fax: 308-235-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number458
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number022
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: