Healthcare Provider Details

I. General information

NPI: 1346566163
Provider Name (Legal Business Name): HEALTH AT HOME CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S 90TH ST
LINCOLN NE
68526-9224
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 402-875-2500
  • Fax:
Mailing address:
  • Phone: 402-328-2907
  • Fax: 888-965-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number111117
License Number StateNE

VIII. Authorized Official

Name: JAMIE R STAAB-PETERS
Title or Position: MEMBER MANAGER
Credential: APRN
Phone: 402-875-2500