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General NPI Number Information
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NPI Number | 1831577246
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Entity Type | Organization
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Legal Business Name | REANNA POTTER
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 14301 FNB PKWY SUITE 100
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City | OMAHA
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State | NE
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Zip | 68154-7200
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Country | US
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Telephone | 402-739-8061
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Fax |
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Provider Business Mailing Address
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Address Line | 5331 N 36TH AVE
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City | OMAHA
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State | NE
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Zip | 68111-1563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CNA
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Name | REANNA DEE POTTER
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Credential |
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Telephone | 402-739-8061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 73227
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License Number State | NE
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