Healthcare Provider Details

I. General information

NPI: 1295239366
Provider Name (Legal Business Name): KATHY RAAB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 ROGERS DR
PAPILLION NE
68046-6143
US

IV. Provider business mailing address

1307 ROGERS DR
PAPILLION NE
68046-6143
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-0469
  • Fax: 402-898-0472
Mailing address:
  • Phone: 402-898-0469
  • Fax: 402-898-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number60553
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: