MEDICARE: TRANSFORMATIVE HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1043865165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIVE HEALTHCARE

Provider Business Mailing Address
First Line	:	11810 NICHOLAS ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4449
Country	:	US
Telephone Number	:	402-307-5510
Fax Number	:	402-204-1081

Provider Business Practice Location Address
First Line	:	11810 NICHOLAS ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4449
Country	:	US
Telephone Number	:	402-307-5510
Fax Number	:	402-204-1081

Authorized Official
Title or Position	:	NURSE PRACTITIONER / OWNER
Name	:	CASSIE KRAUSE
Credential	:	APRN
Telephone Number	:	402-307-5510

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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