Healthcare Provider Details

I. General information

NPI: 1336945682
Provider Name (Legal Business Name): STEPHANIE MARIE HULBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15625 ROSEWOOD ST APT 8
OMAHA NE
68136-3309
US

IV. Provider business mailing address

15625 ROSEWOOD ST APT 8
OMAHA NE
68136-3309
US

V. Phone/Fax

Practice location:
  • Phone: 402-613-8010
  • Fax:
Mailing address:
  • Phone: 402-613-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number142247
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: