Healthcare Provider Details

I. General information

NPI: 1881075133
Provider Name (Legal Business Name): ELISA ZNAMENACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 70TH ST
LINCOLN NE
68510-2462
US

IV. Provider business mailing address

3941 EAGLE RIDGE RD APT 102
LINCOLN NE
68516-7046
US

V. Phone/Fax

Practice location:
  • Phone: 402-327-9990
  • Fax:
Mailing address:
  • Phone: 402-327-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number65899
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: