Healthcare Provider Details

I. General information

NPI: 1063700730
Provider Name (Legal Business Name): SALLY ANN HRDY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 CALIFORNIA ST
OMAHA NE
68154-5233
US

IV. Provider business mailing address

13660 CALIFORNIA ST
OMAHA NE
68154-5233
US

V. Phone/Fax

Practice location:
  • Phone: 402-965-8800
  • Fax:
Mailing address:
  • Phone: 402-965-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number31176
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: