Healthcare Provider Details

I. General information

NPI: 1104749464
Provider Name (Legal Business Name): EMILY MICHELLE DIVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 IRENE ST
BELLEVUE NE
68147-1949
US

IV. Provider business mailing address

2914 IRENE ST
BELLEVUE NE
68147-1949
US

V. Phone/Fax

Practice location:
  • Phone: 402-916-0079
  • Fax:
Mailing address:
  • Phone: 402-916-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: