Provider Demographics
NPI:1962219758
Name:BALTENSPERGER, BEV
Entity type:Individual
Prefix:
First Name:BEV
Middle Name:
Last Name:BALTENSPERGER
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 1:6243 P RD
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-6559
Mailing Address - Country:US
Mailing Address - Phone:402-209-3246
Mailing Address - Fax:
Practice Address - Street 1:200 N 3RD ST
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2525
Practice Address - Country:US
Practice Address - Phone:402-209-3246
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
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services