1548691330 NPI number — CARLEE L HECK LIMHP

Table of content: CARLEE L HECK LIMHP (NPI 1548691330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548691330 NPI number — CARLEE L HECK LIMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HECK
Provider First Name:
CARLEE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LIMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSEN
Provider Other First Name:
CARLEE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548691330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10250 REGENCY CIR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-3728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-370-9147
Provider Business Mailing Address Fax Number:
402-939-0846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10826 OLD MILL RD STE 103-8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-370-9147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1924 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)