Healthcare Provider Details

I. General information

NPI: 1922893536
Provider Name (Legal Business Name): LORI MARSHALL-BOGDAN CNA, MEDICATION AIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI MARSHALL-BOGDAN

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10717 VIRGINIA PLZ STE 113
LA VISTA NE
68128-3255
US

IV. Provider business mailing address

1022 HAVERFORD DR
PAPILLION NE
68046-6213
US

V. Phone/Fax

Practice location:
  • Phone: 402-414-4879
  • Fax:
Mailing address:
  • Phone: 531-270-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2846523
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: