1174328736 NPI number — MRS. RUBY ROSE VILLENA BANDIGAN

Table of content: MRS. RUBY ROSE VILLENA BANDIGAN (NPI 1174328736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174328736 NPI number — MRS. RUBY ROSE VILLENA BANDIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANDIGAN
Provider First Name:
RUBY ROSE
Provider Middle Name:
VILLENA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174328736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 GALVIN RD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-769-9225
Provider Business Mailing Address Fax Number:
402-585-0081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16134 W STREET
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:
68135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-210-1077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2025

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: 373H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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