Healthcare Provider Details

I. General information

NPI: 1407148448
Provider Name (Legal Business Name): GENIVA SCOTT DOENHOEFER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX A
WINNEBAGO NE
68071-0841
US

IV. Provider business mailing address

PO BOX A
WINNEBAGO NE
68071-0841
US

V. Phone/Fax

Practice location:
  • Phone: 402-878-2480
  • Fax: 402-878-2204
Mailing address:
  • Phone: 402-878-2480
  • Fax: 402-878-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: