Healthcare Provider Details

I. General information

NPI: 1902469380
Provider Name (Legal Business Name): ANN MARIE HUNT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2019
Last Update Date: 04/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 LUCILE DR STE 100
LINCOLN NE
68506-6032
US

IV. Provider business mailing address

1940 226TH ST
EAGLE NE
68347-1804
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7631
  • Fax:
Mailing address:
  • Phone: 402-467-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1520
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: