Healthcare Provider Details

I. General information

NPI: 1275437071
Provider Name (Legal Business Name): KRISTIN LOUISE MAAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E 20TH PL STE 200D
SCOTTSBLUFF NE
69361-2874
US

IV. Provider business mailing address

6902 PINE ST
OMAHA NE
68106-2855
US

V. Phone/Fax

Practice location:
  • Phone: 308-633-7025
  • Fax:
Mailing address:
  • Phone: 308-765-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: