Healthcare Provider Details

I. General information

NPI: 1083306872
Provider Name (Legal Business Name): NOLAN HIMMELBERG CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE # 121
OMAHA NE
68105-1850
US

IV. Provider business mailing address

900 FARNAM ST APT 814
OMAHA NE
68102-5092
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-5988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO04647
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO04647
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: