Healthcare Provider Details

I. General information

NPI: 1164300554
Provider Name (Legal Business Name): BONNIE KORT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD
OMAHA NE
68124-1933
US

IV. Provider business mailing address

19602 W ST
OMAHA NE
68135-4246
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number96964
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: