Healthcare Provider Details

I. General information

NPI: 1144102203
Provider Name (Legal Business Name): ISABEL BOTHWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N CLARKSON ST
FREMONT NE
68025-4254
US

IV. Provider business mailing address

20908 HAMPTON CIR
GRETNA NE
68028-3982
US

V. Phone/Fax

Practice location:
  • Phone: 402-941-6359
  • Fax:
Mailing address:
  • Phone: 402-452-8917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: