MEDICARE: MRS. KIMBERLY DAWN SCRIVNER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1144526393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY DAWN SCRIVNER

Provider Business Mailing Address
First Line	:	2935 PINE LAKE RD STE F
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-6009
Country	:	US
Telephone Number	:	402-261-4017
Fax Number	:	402-261-9185

Provider Business Practice Location Address
First Line	:	2935 PINE LAKE RD STE F
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-6009
Country	:	US
Telephone Number	:	402-261-4017
Fax Number	:	402-261-9185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	01/09/2014

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