Healthcare Provider Details

I. General information

NPI: 1205374295
Provider Name (Legal Business Name): CORY A NYENHUIS L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 N 108TH ST
OMAHA NE
68164-2943
US

IV. Provider business mailing address

3830 N 108TH ST
OMAHA NE
68164-2943
US

V. Phone/Fax

Practice location:
  • Phone: 402-515-2412
  • Fax: 402-592-0689
Mailing address:
  • Phone: 402-515-2412
  • Fax: 402-592-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number37
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: