Healthcare Provider Details

I. General information

NPI: 1639565328
Provider Name (Legal Business Name): DEBRA A HOAG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11819 MIRACLE HILLS DR
OMAHA NE
68154-5308
US

IV. Provider business mailing address

11819 MIRACLE HILLS DR
OMAHA NE
68154-5308
US

V. Phone/Fax

Practice location:
  • Phone: 402-201-2373
  • Fax: 402-201-2432
Mailing address:
  • Phone: 402-201-2373
  • Fax: 402-201-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111795
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF091641
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: