Healthcare Provider Details

I. General information

NPI: 1699780007
Provider Name (Legal Business Name): FAYLENE RAE DANCER HUDSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAYLENE DANCER APRN

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MAPLE, SUITE 105
SUTHERLAND NE
69165
US

IV. Provider business mailing address

PO BOX 218
SUTHERLAND NE
69165-0218
US

V. Phone/Fax

Practice location:
  • Phone: 308-386-4799
  • Fax: 308-386-4343
Mailing address:
  • Phone: 308-386-4799
  • Fax: 308-386-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110778
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: