Healthcare Provider Details

I. General information

NPI: 1538994504
Provider Name (Legal Business Name): CRYSTAL NICOLE EVERETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 S 114TH ST STE 4
OMAHA NE
68137-2310
US

IV. Provider business mailing address

4940 S 114TH ST STE 4
OMAHA NE
68137-2310
US

V. Phone/Fax

Practice location:
  • Phone: 402-671-1661
  • Fax: 402-982-4099
Mailing address:
  • Phone: 402-671-1661
  • Fax: 402-982-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number87779
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: