Healthcare Provider Details

I. General information

NPI: 1316835564
Provider Name (Legal Business Name): NESTORA OTRA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E 13TH ST
CRETE NE
68333-2200
US

IV. Provider business mailing address

445 E 13TH ST
CRETE NE
68333-2200
US

V. Phone/Fax

Practice location:
  • Phone: 402-826-0406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: