Healthcare Provider Details

I. General information

NPI: 1477793453
Provider Name (Legal Business Name): KRISTA L SKAR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12565 W CENTER RD SUITE 100
OMAHA NE
68144-3802
US

IV. Provider business mailing address

12565 W CENTER RD SUITE 100
OMAHA NE
68144-3802
US

V. Phone/Fax

Practice location:
  • Phone: 402-342-5566
  • Fax: 402-930-4066
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: