Healthcare Provider Details

I. General information

NPI: 1750771671
Provider Name (Legal Business Name): CHANDRA HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

3610 N 163RD PLZ STE 204
OMAHA NE
68116-2164
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7411
  • Fax:
Mailing address:
  • Phone: 402-740-9602
  • Fax: 402-913-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7075
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2071
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: