Healthcare Provider Details

I. General information

NPI: 1992882062
Provider Name (Legal Business Name): BECCA ELISE ENGELKEMIER CNM, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 S 30TH ST
OMAHA NE
68107-1521
US

IV. Provider business mailing address

4920 S 30TH ST SUITE 103
OMAHA NE
68107-1590
US

V. Phone/Fax

Practice location:
  • Phone: 402-734-4110
  • Fax: 402-734-3990
Mailing address:
  • Phone: 402-734-4110
  • Fax: 402-734-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111733
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number120062
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: