Healthcare Provider Details

I. General information

NPI: 1366264046
Provider Name (Legal Business Name): JUSTINA MARIE HOTTOVY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 BURR OAK DR
PLATTSMOUTH NE
68048-6500
US

IV. Provider business mailing address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

V. Phone/Fax

Practice location:
  • Phone: 402-215-1622
  • Fax:
Mailing address:
  • Phone: 402-995-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number70856
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: