Healthcare Provider Details

I. General information

NPI: 1104639723
Provider Name (Legal Business Name): MAKAELA RAE URBANOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAKAELA RAE OLTMAN

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7562 UPTON GREY LN
LINCOLN NE
68516-5694
US

IV. Provider business mailing address

7562 UPTON GREY LN
LINCOLN NE
68516-5694
US

V. Phone/Fax

Practice location:
  • Phone: 402-890-6550
  • Fax: 402-325-1619
Mailing address:
  • Phone: 402-890-6550
  • Fax: 402-325-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: