Provider Demographics
NPI:1679734008
Name:PRUIS-TRAPP, ASHLEE SUE (BA)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:SUE
Last Name:PRUIS-TRAPP
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:TRAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-2807
Mailing Address - Country:US
Mailing Address - Phone:402-397-9866
Mailing Address - Fax:402-397-1404
Practice Address - Street 1:5115 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-2807
Practice Address - Country:US
Practice Address - Phone:402-690-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076510700Medicaid