Healthcare Provider Details

I. General information

NPI: 1164353108
Provider Name (Legal Business Name): ELIZABETH HEUERTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16120 W DODGE RD
OMAHA NE
68118-2049
US

IV. Provider business mailing address

1730 N 176TH PLZ
OMAHA NE
68118-6029
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-5055
  • Fax: 712-396-4145
Mailing address:
  • Phone: 402-391-5055
  • Fax: 712-396-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number89113
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: