Organization
ST CROIX NEBRASKA SIP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY A OLSON (CHIEF COMPLIANCE OFFICER)
(651) 237-9716
Entity
Organization
Contact information
Practice address
1065 N 115TH ST STE 120, OMAHA, NE 68154-4423
(402) 609-4818
Mailing address
1065 N 115TH ST STE 120, OMAHA, NE 68154-4423
(402) 609-4818
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
171M00000X
Case Manager/Care Coordinator
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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