Healthcare Provider Details

I. General information

NPI: 1407539208
Provider Name (Legal Business Name): KATHLEEN ANN ANTHONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN COENEN RN

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST STE 300
OMAHA NE
68114-4108
US

IV. Provider business mailing address

PO BOX 2797
OMAHA NE
68103-2797
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-5250
  • Fax:
Mailing address:
  • Phone: 402-354-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78121
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114980
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: