Healthcare Provider Details

I. General information

NPI: 1922929645
Provider Name (Legal Business Name): QIUSHI FAN M.M.N., B.MED., RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRED & PAMELA BUFFETT CANCER CENTER, 505 S 45TH ST 8.12.391
OMAHA NE
68106-6861
US

IV. Provider business mailing address

836 PARK AVE APT 304
OMAHA NE
68105-2173
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86374030
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: