Provider Demographics
NPI:1932905437
Name:CONN-FOOTE, TINA MARIE
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:CONN-FOOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:CONN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 VOORHIS ST
Mailing Address - Street 2:
Mailing Address - City:C.B. COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503
Mailing Address - Country:US
Mailing Address - Phone:712-310-4533
Mailing Address - Fax:
Practice Address - Street 1:1820 HILLCREST DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:402-682-6599
Practice Address - Fax:402-682-6563
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant