Healthcare Provider Details

I. General information

NPI: 1003060864
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL - DIABETES EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE STREET CHILDREN'S HOSPITAL - DIABETES EDUCATION
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE STREET CHILDREN'S HOSPITAL - DIABETES EDUCATION
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3871
  • Fax: 402-955-8738
Mailing address:
  • Phone: 402-955-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NANCY BARNA
Title or Position: INTERNAL AUDIT MANAGER
Credential: MPA, MS, FHFMA, CPC
Phone: 402-955-6775