Individual
ANETRIUS SHANTELL VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1502 N 70TH AVE, OMAHA, NE 68104-4621
(402) 714-2843
Mailing address
3606 S 67TH CT APT 25, OMAHA, NE 68106-4250
(402) 714-2843
(402) 714-2843
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
03/03/2025
Last updated
12/05/2025
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