Healthcare Provider Details

I. General information

NPI: 1033035514
Provider Name (Legal Business Name): PHILLIP DOREMUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 N 191ST ST
ELKHORN NE
68022-5839
US

IV. Provider business mailing address

4621 N 191ST ST
ELKHORN NE
68022-5839
US

V. Phone/Fax

Practice location:
  • Phone: 402-320-1572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: