Healthcare Provider Details

I. General information

NPI: 1679241202
Provider Name (Legal Business Name): RAMADA LEEANN HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 S 77TH AVE
OMAHA NE
68124-3440
US

IV. Provider business mailing address

3269 S 77TH AVE
OMAHA NE
68124-3440
US

V. Phone/Fax

Practice location:
  • Phone: 402-706-0688
  • Fax:
Mailing address:
  • Phone: 402-706-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number23178
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: