Healthcare Provider Details

I. General information

NPI: 1780518936
Provider Name (Legal Business Name): AUTUMN ASHLEY ORR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 N WEBB RD UNIT 4
GRAND ISLAND NE
68803-1756
US

IV. Provider business mailing address

445 9TH AVE
FAIRMONT NE
68354-9500
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-1690
  • Fax:
Mailing address:
  • Phone: 308-381-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number105857
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: