Individual
NE NE TAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14813 MARY ST, OMAHA, NE 68116-4402
(720) 732-7798
(402) 939-0385
Mailing address
8620 N 96TH ST, OMAHA, NE 68122-2300
(402) 708-8209
(402) 939-0385
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
01/07/2026
Last updated
01/07/2026
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