Healthcare Provider Details

I. General information

NPI: 1346420460
Provider Name (Legal Business Name): NICOLE ROSE HOFSTETTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7032 EAGLE DR
LINCOLN NE
68507-2146
US

IV. Provider business mailing address

7032 EAGLE DR.
LINCOLN NE
68507
US

V. Phone/Fax

Practice location:
  • Phone: 402-540-5734
  • Fax:
Mailing address:
  • Phone: 402-540-5734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number586
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: