Healthcare Provider Details

I. General information

NPI: 1255295663
Provider Name (Legal Business Name): SAMANTHA CROUSE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7906 S 155TH AVE
OMAHA NE
68138-7467
US

IV. Provider business mailing address

7906 S 155TH AVE
OMAHA NE
68138-7467
US

V. Phone/Fax

Practice location:
  • Phone: 402-595-0468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1992
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: