Individual
ANDIE DETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7921 S 190TH AVE, OMAHA, NE 68136-1207
(623) 221-0007
Mailing address
7921 S 190TH AVE, OMAHA, NE 68136-1207
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
04/17/2025
Last updated
04/17/2025
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