Healthcare Provider Details

I. General information

NPI: 1477049013
Provider Name (Legal Business Name): EILEEN MARIE DINEEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN MARIE DWORAK

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14161 FRANKLIN ST
OMAHA NE
68154-3865
US

IV. Provider business mailing address

14161 FRANKLIN ST
OMAHA NE
68154-3865
US

V. Phone/Fax

Practice location:
  • Phone: 402-301-1426
  • Fax:
Mailing address:
  • Phone: 402-301-1426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number112503
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: