Healthcare Provider Details

I. General information

NPI: 1881804490
Provider Name (Legal Business Name): DONNA LYNN MORRIS RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDIAN HILLS DR
MACY NE
68039
US

IV. Provider business mailing address

PO BOX 250
MACY NE
68039-0250
US

V. Phone/Fax

Practice location:
  • Phone: 402-837-5381
  • Fax: 402-837-4424
Mailing address:
  • Phone: 402-837-5381
  • Fax: 402-837-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberR07405
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: