MEDICARE: TIMARA KROEGER

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	163WS0200X	School Registered Nurse	42362	NE

General Provider Information

NPI Number	:	1215410444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMARA KROEGER

Provider Business Mailing Address
First Line	:	2606 HAMILTON ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1640
Country	:	US
Telephone Number	:	402-344-3385
Fax Number	:	402-344-3724

Provider Business Practice Location Address
First Line	:	2606 HAMILTON ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1640
Country	:	US
Telephone Number	:	402-344-3385
Fax Number	:	402-344-3724

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

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	09/18/2018

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Directions to “ TIMARA KROEGER ” Practice Location

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