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General NPI Number Information
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NPI Number | 1831397751
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Entity Type | Organization
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Legal Business Name | HUSKER OCCUPATIONAL MEDICINE
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 W BROADWAY SUITE 201
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0842
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Country | US
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Telephone | 712-352-0653
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Fax | 712-352-0656
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Provider Business Mailing Address
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Address Line | 500 W BROADWAY SUITE 201
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0842
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Country | US
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Telephone | 712-352-0653
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Fax | 712-352-0656
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. TAMI RIHA
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Credential |
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Telephone | 712-352-0653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A-117058
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License Number State | IA
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