Healthcare Provider Details

I. General information

NPI: 1477350213
Provider Name (Legal Business Name): BRIDGER HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 S 114TH ST
OMAHA NE
68137-2329
US

IV. Provider business mailing address

140 BENTON ST
COUNCIL BLUFFS IA
51503-3133
US

V. Phone/Fax

Practice location:
  • Phone: 402-827-7652
  • Fax:
Mailing address:
  • Phone: 531-205-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: