Healthcare Provider Details

I. General information

NPI: 1689456238
Provider Name (Legal Business Name): ANDREA RAE WARREN PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10665 BEDFORD AVE STE 200
OMAHA NE
68134-3682
US

IV. Provider business mailing address

10665 BEDFORD AVE STE 200
OMAHA NE
68134-3682
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-8323
  • Fax: 402-937-8324
Mailing address:
  • Phone: 402-937-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number13590
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: