Healthcare Provider Details

I. General information

NPI: 1225850860
Provider Name (Legal Business Name): LARA COLTON BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1873
US

IV. Provider business mailing address

4101 WOOLWORTH AVENUE
OMAHA NE
68105
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-4006
  • Fax:
Mailing address:
  • Phone: 402-995-4006
  • Fax: 402-977-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number62676
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: