Healthcare Provider Details

I. General information

NPI: 1376178970
Provider Name (Legal Business Name): SEBASTIAN EUGENE EDWARDS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 S 70TH STREET SUITE # 450
LINCOLN NE
68506-3796
US

IV. Provider business mailing address

2900 S 70TH STREET SUITE # 450
LINCOLN NE
68506-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-4186
  • Fax: 402-489-5279
Mailing address:
  • Phone: 402-489-4186
  • Fax: 402-489-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101577
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: