MEDICARE: MRS. SUZANNE DIVETT CHORE PROVIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629267927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE DIVETT CHORE PROVIDER

Provider Business Mailing Address
First Line	:	16909 LAKESIDE HILLS PLZ STE 114
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-4652
Country	:	US
Telephone Number	:	402-932-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	16909 LAKESIDE HILLS PLZ STE 114
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-4652
Country	:	US
Telephone Number	:	402-932-2211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	01/17/2025

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