Healthcare Provider Details

I. General information

NPI: 1760820575
Provider Name (Legal Business Name): STEFAN CERU HEMMINGS M.B., B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD STE 426
OMAHA NE
68124-2323
US

IV. Provider business mailing address

7710 MERCY RD STE 426
OMAHA NE
68124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 402-343-8650
  • Fax: 401-343-8545
Mailing address:
  • Phone: 402-343-8650
  • Fax: 401-343-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD-53109
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE-10971
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36321
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: