Healthcare Provider Details

I. General information

NPI: 1245980762
Provider Name (Legal Business Name): REBECCA HYNES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 CASS ST
OMAHA NE
68132-2913
US

IV. Provider business mailing address

4908 CASS ST
OMAHA NE
68132-2913
US

V. Phone/Fax

Practice location:
  • Phone: 402-249-6136
  • Fax: 402-502-6823
Mailing address:
  • Phone: 402-249-6136
  • Fax: 402-502-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114110
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: