Healthcare Provider Details

I. General information

NPI: 1437961752
Provider Name (Legal Business Name): POLLY L POPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N PINE ST
HOOPER NE
68031-3072
US

IV. Provider business mailing address

348 W 21ST AVE
FREMONT NE
68025-2525
US

V. Phone/Fax

Practice location:
  • Phone: 402-654-2024
  • Fax:
Mailing address:
  • Phone: 402-317-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: