Provider Demographics
NPI:1508422635
Name:ZEGERS, CARLI A (RN)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:A
Last Name:ZEGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARLI
Other - Middle Name:A
Other - Last Name:CULJAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:933 E PIERCE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4626
Practice Address - Country:US
Practice Address - Phone:712-396-6111
Practice Address - Fax:712-396-7026
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76901163W00000X
NE112791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse