Individual
DOMINIC EVIN GROENHAGEN-BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5155 S 124TH AVE, OMAHA, NE 68137-2128
(402) 690-8045
Mailing address
5155 S 124TH AVE, OMAHA, NE 68137-2128
(402) 690-8045
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
04/28/2025
Last updated
04/27/2026
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