Healthcare Provider Details

I. General information

NPI: 1528877784
Provider Name (Legal Business Name): ANDREW CRAIG ROHLOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 QUEENS TERRACE
OMAHA NE
68142-5150
US

IV. Provider business mailing address

PO BOX 308
BENNINGTON NE
68007-0308
US

V. Phone/Fax

Practice location:
  • Phone: 402-541-6596
  • Fax:
Mailing address:
  • Phone: 402-541-6596
  • 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: