Healthcare Provider Details

I. General information

NPI: 1053245282
Provider Name (Legal Business Name): EMMANAUEL ANGLOW
Entity Type: Individual
Gender: Male
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

1709 W 39TH ST
KEARNEY NE
68845-8230
US

IV. Provider business mailing address

4014 REED RD
GRAND ISLAND NE
68803-3921
US

V. Phone/Fax

Practice location:
  • Phone: 308-293-2174
  • Fax:
Mailing address:
  • Phone:
  • 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: