Healthcare Provider Details

I. General information

NPI: 1275287393
Provider Name (Legal Business Name): NEBRASKA PEDIATRIC PRACTICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/21/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8552 CASS ST CHILDRENS ENDOCRINOLOGY DIABETES EDUCATION PROGRAM
OMAHA NE
68114-3567
US

IV. Provider business mailing address

8552 CASS ST CHILDRENS ENDOCRINOLOGY DIABETES EDUCATION PROGRAM
OMAHA NE
68114-3567
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3871
  • Fax: 402-955-8738
Mailing address:
  • Phone: 402-955-3871
  • Fax: 402-955-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: AMY HATCHER
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 402-955-6795