Healthcare Provider Details

I. General information

NPI: 1215474879
Provider Name (Legal Business Name): ABIGAIL KAY CHASE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL KAY NIETFIELD

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 COUNTY ROAD J
WAHOO NE
68066-4152
US

IV. Provider business mailing address

1760 COUNTY ROAD J
WAHOO NE
68066-4152
US

V. Phone/Fax

Practice location:
  • Phone: 402-443-4191
  • Fax: 402-443-1402
Mailing address:
  • Phone: 402-443-4191
  • Fax: 402-443-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112169
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: