Healthcare Provider Details

I. General information

NPI: 1235952052
Provider Name (Legal Business Name): MELISSA BAUMGART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 N 124TH ST
OMAHA NE
68142-1601
US

IV. Provider business mailing address

7310 N 124TH ST
OMAHA NE
68142-1601
US

V. Phone/Fax

Practice location:
  • Phone: 402-714-3192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number71113
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: