Healthcare Provider Details

I. General information

NPI: 1053096263
Provider Name (Legal Business Name): KENDALL NIEHAUS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 23RD ST
FREMONT NE
68025-2592
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-815-7800
  • Fax: 402-815-9119
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3074
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: