Healthcare Provider Details

I. General information

NPI: 1962249052
Provider Name (Legal Business Name): CEISHA DEITERING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVENUE
OMAHA NE
68105
US

IV. Provider business mailing address

16827 L CIRCLE
OMAHA NE
68135
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-5838
  • Fax:
Mailing address:
  • Phone: 402-995-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number68645
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: