Healthcare Provider Details

I. General information

NPI: 1578496345
Provider Name (Legal Business Name): TIA MARIE VENTURINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 15TH ST
GERING NE
69341-2316
US

IV. Provider business mailing address

PO BOX 1327
SCOTTSBLUFF NE
69363-1327
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-0021
  • Fax:
Mailing address:
  • Phone: 308-675-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: