Healthcare Provider Details

I. General information

NPI: 1003318098
Provider Name (Legal Business Name): LAVONNE JEAN HOHENFELDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 ORCHARD ST
LINCOLN NE
68504-3264
US

IV. Provider business mailing address

5021 ORCHARD ST
LINCOLN NE
68504-3264
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1164
  • Fax: 402-458-3264
Mailing address:
  • Phone: 402-436-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number3329
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: