Healthcare Provider Details

I. General information

NPI: 1609780717
Provider Name (Legal Business Name): SUSANA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 BORMAN ST
BELLEVUE NE
68157-2319
US

IV. Provider business mailing address

12308 S 205TH AVE
GRETNA NE
68028-8157
US

V. Phone/Fax

Practice location:
  • Phone: 402-981-1186
  • Fax:
Mailing address:
  • Phone: 402-813-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: