Provider Demographics
NPI:1356158190
Name:RODRIGUEZ, KYLE NICHOLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:NICHOLE
Last Name:RODRIGUEZ
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 1:4852 S 143RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1501
Mailing Address - Country:US
Mailing Address - Phone:402-690-6044
Mailing Address - Fax:
Practice Address - Street 1:4852 S 143RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1501
Practice Address - Country:US
Practice Address - Phone:402-690-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion