Healthcare Provider Details

I. General information

NPI: 1477186757
Provider Name (Legal Business Name): HUONG LE PSYCHIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 02/15/2020
Certification Date: 02/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 86TH ST STE 102
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

4444 S 86TH ST STE 102
LINCOLN NE
68526-9253
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax:
Mailing address:
  • Phone: 402-476-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KADRA OMEROVIC
Title or Position: CREDENTIALING
Credential:
Phone: 402-421-1182