Provider Demographics
NPI:1407628795
Name:HIETT, SELENA
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:HIETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 F ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NE
Mailing Address - Zip Code:68418-4140
Mailing Address - Country:US
Mailing Address - Phone:402-780-5327
Mailing Address - Fax:
Practice Address - Street 1:50 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:BENNET
Practice Address - State:NE
Practice Address - Zip Code:68317-2029
Practice Address - Country:US
Practice Address - Phone:402-780-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant