Healthcare Provider Details

I. General information

NPI: 1114584745
Provider Name (Legal Business Name): ANGELA MARIE KRAFKA AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST
LINCOLN NE
68506-1283
US

IV. Provider business mailing address

7047 N GRAND LAKE DR
LINCOLN NE
68521-9094
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-8566
  • Fax: 402-481-8805
Mailing address:
  • Phone: 402-560-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number79679
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number112816
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: