Organization
PONCA TRIBE OF NEBRASKA
Active
Organization
PONCA TRIBE OF NEBRASKA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY M RIEB MS (CONTRACT SERVICE ADMINISTRATOR)
(402) 738-3175
Entity
Organization
Contact information
Practice address
2602 J ST, OMAHA, NE 68107-1643
(402) 734-5275
(402) 734-5708
Mailing address
2602 J ST, OMAHA, NE 68107-1643
(402) 734-5275
(402) 734-5708
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1155
LICENSED MEDICAL NUTRITION THERAPIST
NE
01
—
86004356
COMMISSION ON DIETETIC REGISTRATION
NE
Enumeration date
09/09/2014
Last updated
09/09/2014
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