=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104227131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ELIZABETH ANN ZUNIGA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2014
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4940 O ST # 1013
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-413-6263
-----------------------------------------------------
Fax | 531-310-5965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4940 O ST # 1013
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-413-6263
-----------------------------------------------------
Fax | 531-310-5965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 15609685
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------