Healthcare Provider Details

I. General information

NPI: 1184395519
Provider Name (Legal Business Name): ALLYSE ANN KLEIBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST FL 7
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

5763 NW 14TH ST
LINCOLN NE
68521-4242
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8444
  • Fax:
Mailing address:
  • Phone: 612-390-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10838364
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: