Healthcare Provider Details

I. General information

NPI: 1699394981
Provider Name (Legal Business Name): LACEY JUNE HUTCHESON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 400
LINCOLN NE
68506-1278
US

IV. Provider business mailing address

PO BOX 6607
LINCOLN NE
68506-0607
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-8500
  • Fax: 402-481-8501
Mailing address:
  • Phone: 402-483-3333
  • Fax: 402-483-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79706
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113153
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: