Healthcare Provider Details

I. General information

NPI: 1407791916
Provider Name (Legal Business Name): REAGAN A KLOOZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 MAYBERRY ST APT 3301
OMAHA NE
68106-1779
US

IV. Provider business mailing address

5110 MAYBERRY ST APT 3301
OMAHA NE
68106-1779
US

V. Phone/Fax

Practice location:
  • Phone: 605-999-4333
  • Fax:
Mailing address:
  • Phone: 605-999-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number98410
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: