1932373966 NPI number — MS. HEATHER JO DUHACHEK-CHASE MS, LIMHP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932373966 NPI number — MS. HEATHER JO DUHACHEK-CHASE MS, LIMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUHACHEK-CHASE
Provider First Name:
HEATHER
Provider Middle Name:
JO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LIMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOODY
Provider Other First Name:
HEATHER
Provider Other Middle Name:
JO DUHACHEK
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PLMHP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932373966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6677 SORENSEN PARKWAY
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:
68152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-932-8884
Provider Business Mailing Address Fax Number:
402-932-8885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6681 SORENSEN PKWY
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:
68152-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-932-8884
Provider Business Practice Location Address Fax Number:
402-932-8885
Provider Enumeration Date:
04/22/2008

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:  1078 , 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)

  • Identifier: 47082303526 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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