Healthcare Provider Details

I. General information

NPI: 1619839289
Provider Name (Legal Business Name): ROBERTA LEE TETEN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

1212 3RD CORSO
NEBRASKA CITY NE
68410-2712
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-3495
  • Fax:
Mailing address:
  • Phone: 402-995-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1855
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: