Healthcare Provider Details

I. General information

NPI: 1891617825
Provider Name (Legal Business Name): NYAGOA TUT DHURORDIENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4506 S 215TH AVE
ELKHORN NE
68022-3355
US

IV. Provider business mailing address

4506 S 215TH AVE
ELKHORN NE
68022-3355
US

V. Phone/Fax

Practice location:
  • Phone: 402-813-3400
  • Fax: 402-813-3400
Mailing address:
  • Phone: 402-813-3400
  • Fax: 402-813-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: