Healthcare Provider Details

I. General information

NPI: 1841235413
Provider Name (Legal Business Name): ELLEN THERESA HUTTEGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 S 176TH AVE
OMAHA NE
68135-3437
US

IV. Provider business mailing address

4968 S 176TH AVE
OMAHA NE
68135-3437
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-3845
  • Fax: 402-449-4885
Mailing address:
  • Phone: 402-934-3845
  • Fax: 402-449-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704230225
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: