Healthcare Provider Details

I. General information

NPI: 1235962119
Provider Name (Legal Business Name): KORBY HEGY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KORBY WACKER

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N 93RD ST
OMAHA NE
68134-4717
US

IV. Provider business mailing address

1431 E 5TH ST
FREMONT NE
68025-5340
US

V. Phone/Fax

Practice location:
  • Phone: 877-859-0589
  • Fax:
Mailing address:
  • Phone: 402-719-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number115540
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: