MEDICARE: MICHELLE RENEE HRUSKA LIMHP, LADC

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	101Y00000X	Counselor	763	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800	OTHER	NE	LADC LICENSE
2	763	OTHER	NE	LIMHP LICENSE

General Provider Information

NPI Number	:	1669798161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE HRUSKA LIMHP, LADC

Provider Business Mailing Address
First Line	:	PO BOX 2797
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-2797
Country	:	US
Telephone Number	:	402-354-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9239 W CENTER RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-1933
Country	:	US
Telephone Number	:	402-354-8000
Fax Number	:

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

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	10/21/2010

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