Healthcare Provider Details

I. General information

NPI: 1700285939
Provider Name (Legal Business Name): MELLISA RENAE KAREL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CALIFORNIA PLZ
OMAHA NE
68178-0212
US

IV. Provider business mailing address

2500 CALIFORNIA PLZ
OMAHA NE
68178-0212
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-5056
  • Fax: 402-280-5094
Mailing address:
  • Phone: 402-280-5056
  • Fax: 402-280-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2186
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: