Healthcare Provider Details

I. General information

NPI: 1740146174
Provider Name (Legal Business Name): ANDREW J CLARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E MILITARY AVE
FREMONT NE
68025-5489
US

IV. Provider business mailing address

15807 BANCROFT CT APT 1338
OMAHA NE
68130-1880
US

V. Phone/Fax

Practice location:
  • Phone: 402-317-3228
  • Fax:
Mailing address:
  • Phone: 402-403-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: