Healthcare Provider Details

I. General information

NPI: 1730977513
Provider Name (Legal Business Name): DOMINIQUE LASHEA GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 HILLCREST DR
BELLEVUE NE
68005-3636
US

IV. Provider business mailing address

3631 S ST
OMAHA NE
68107-3221
US

V. Phone/Fax

Practice location:
  • Phone: 402-682-6599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: