Healthcare Provider Details

I. General information

NPI: 1639821267
Provider Name (Legal Business Name): SCOTTSBLUFF COUNTY SCHOOL DISTRICT 11
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 JEFFERSON AVE
MORRILL NE
69358-5013
US

IV. Provider business mailing address

508 JEFFERSON AVE
MORRILL NE
69358-5013
US

V. Phone/Fax

Practice location:
  • Phone: 308-247-3414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JENNY PRAGNELL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 308-247-3414