Provider Demographics
NPI:1578350195
Name:PREISTER, DOUGLAS LEE SR
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEE
Last Name:PREISTER
Suffix:SR
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 1:6463 COUNTY ROAD P39
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5186
Mailing Address - Country:US
Mailing Address - Phone:402-850-6076
Mailing Address - Fax:
Practice Address - Street 1:6463 COUNTY ROAD P39
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5186
Practice Address - Country:US
Practice Address - Phone:402-850-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant