Healthcare Provider Details

I. General information

NPI: 1578377479
Provider Name (Legal Business Name): NYLA N GASTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E 3RD ST
JUNIATA NE
68955-2291
US

IV. Provider business mailing address

108 E 3RD ST
JUNIATA NE
68955-2291
US

V. Phone/Fax

Practice location:
  • Phone: 402-902-9404
  • Fax:
Mailing address:
  • Phone: 402-902-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: