Doctor Name: | CARLA SUE CHURCH |
NPI Number: | 1295054054 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 4501 S 70th St Suite 140 Lincoln, NE - 685164201 |
Business Phone Number: | 4024845100 |
Business Fax Number: | 4024845151 |
Mailing Address: | 4501 S 70th St, Suite 140 LINCOLN |
State: | NE |
Postal Code: | 685164201 |
Phone Number: | 4024845100 |
Fax Number: | 4024845151 |
NPI Enumeration Date: | 05/19/2010 |
NPI Last Update Date: | 06/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |