Healthcare Provider Details

I. General information

NPI: 1083321830
Provider Name (Legal Business Name): SYDNEY BRIANNA MATHENY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 FNB PKWY STE 100
OMAHA NE
68154-7200
US

IV. Provider business mailing address

2065 NASH BLVD APT GG6
COUNCIL BLUFFS IA
51501-0994
US

V. Phone/Fax

Practice location:
  • Phone: 402-807-7447
  • Fax:
Mailing address:
  • Phone: 712-890-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: