Healthcare Provider Details

I. General information

NPI: 1013468511
Provider Name (Legal Business Name): MRS. DEANNE AUERELIE FAVINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 S LINCOLN AVE
ROSELAND NE
68973-1842
US

IV. Provider business mailing address

1117 E SOUTH ST
HASTINGS NE
68901-6443
US

V. Phone/Fax

Practice location:
  • Phone: 402-756-6611
  • Fax: 402-756-6613
Mailing address:
  • Phone: 402-463-5611
  • Fax: 402-463-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number232
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: