Provider Demographics
NPI:1427863786
Name:MAX, TASHA F
Entity type:Individual
Prefix:MS
First Name:TASHA
Middle Name:F
Last Name:MAX
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRACI
Other - Middle Name:N
Other - Last Name:DEBOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9100 PEREGRINE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2693
Mailing Address - Country:US
Mailing Address - Phone:816-299-6088
Mailing Address - Fax:
Practice Address - Street 1:9100 PEREGRINE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2693
Practice Address - Country:US
Practice Address - Phone:402-413-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor