Healthcare Provider Details

I. General information

NPI: 1326523705
Provider Name (Legal Business Name): MRS. PAMELA S HYDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 BEDFORD AVE
OMAHA NE
68104-3546
US

IV. Provider business mailing address

348 LOGAN ST
COUNCIL BLUFFS IA
51503-3122
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-7060
  • Fax: 531-299-2479
Mailing address:
  • Phone: 712-310-8335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number098956
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: