Provider Demographics
NPI:1750107892
Name:CARROLL, RUBIE ELIZABETH (RMA)
Entity type:Individual
Prefix:
First Name:RUBIE
Middle Name:ELIZABETH
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:RUBIE
Other - Middle Name:ELIZABETH
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2712 N 194TH CT APT 2A
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2615
Mailing Address - Country:US
Mailing Address - Phone:531-389-2437
Mailing Address - Fax:
Practice Address - Street 1:620 S 31ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1427
Practice Address - Country:US
Practice Address - Phone:531-299-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant