Individual
DOMERLIN SODUSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4905 S 107TH AVE, SUITE 206, OMAHA, NE 68127-1965
(402) 968-1643
Mailing address
4905 S 107TH AVE, SUITE 206, OMAHA, NE 68127-1965
(402) 968-1643
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10024973200
—
NE
Enumeration date
10/28/2014
Last updated
10/28/2014
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