Individual
TRACI MARIE FAHRENHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 N 19TH ST, ORD, NE 68862-1351
(308) 728-5013
Mailing address
320 N 19TH ST, ORD, NE 68862-1351
(308) 728-5013
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
45626
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88-0005
—
NE
Enumeration date
03/25/2019
Last updated
03/25/2019
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