Healthcare Provider Details

I. General information

NPI: 1801017132
Provider Name (Legal Business Name): MELISSA JANE OBERMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA JANE OETKEN

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 COURT ST
CARROLL NE
68723-9603
US

IV. Provider business mailing address

407 COURT ST
CARROLL NE
68723-9603
US

V. Phone/Fax

Practice location:
  • Phone: 402-360-1453
  • Fax:
Mailing address:
  • Phone: 402-360-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: