Provider Demographics
NPI:1316752462
Name:SUBBA, RUDRA B
Entity type:Individual
Prefix:
First Name:RUDRA
Middle Name:B
Last Name:SUBBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-2146
Mailing Address - Country:US
Mailing Address - Phone:402-321-0412
Mailing Address - Fax:402-614-1599
Practice Address - Street 1:14215 WEBER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-2146
Practice Address - Country:US
Practice Address - Phone:402-321-0412
Practice Address - Fax:402-614-1599
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide