Healthcare Provider Details

I. General information

NPI: 1417015280
Provider Name (Legal Business Name): CYNTHIA VANRIPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985450 NE MEDICAL CTR
OMAHA NE
68198-5450
US

IV. Provider business mailing address

985450 NE MEDICAL CTR
OMAHA NE
68198-5450
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-8943
  • Fax:
Mailing address:
  • Phone: 402-559-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number179
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: