Healthcare Provider Details

I. General information

NPI: 1629597026
Provider Name (Legal Business Name): MELANIE JEAN KUGLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5074 AMES AVE
OMAHA NE
68104-2323
US

IV. Provider business mailing address

5074 AMES AVE
OMAHA NE
68104-2323
US

V. Phone/Fax

Practice location:
  • Phone: 402-996-2540
  • Fax: 402-996-2599
Mailing address:
  • Phone: 402-996-2540
  • Fax: 402-996-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP1422
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5081
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: