Healthcare Provider Details

I. General information

NPI: 1912484262
Provider Name (Legal Business Name): ELENITA MARIE DONLEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 EAST CAMPUS LOOP SOUTH
LINCOLN NE
68583
US

IV. Provider business mailing address

3011 LOVELAND DR
LINCOLN NE
68502-5932
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1433
  • Fax:
Mailing address:
  • Phone: 402-314-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2826
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: