Healthcare Provider Details

I. General information

NPI: 1245346030
Provider Name (Legal Business Name): ROBERT MICHAEL PLOUZEK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S 70TH ST
LINCOLN NE
68510-2404
US

IV. Provider business mailing address

5301 AARON CIR
LINCOLN NE
68516-9491
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-7774
  • Fax: 402-423-7774
Mailing address:
  • Phone: 402-423-7774
  • Fax: 402-423-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100791
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: