Healthcare Provider Details

I. General information

NPI: 1659163780
Provider Name (Legal Business Name): RODRICK HURST
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7024 N 89TH AVE
OMAHA NE
68122-5223
US

IV. Provider business mailing address

7024 N 89TH AVE
OMAHA NE
68122-5223
US

V. Phone/Fax

Practice location:
  • Phone: 402-706-0688
  • Fax:
Mailing address:
  • Phone: 402-706-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: