Healthcare Provider Details

I. General information

NPI: 1811810633
Provider Name (Legal Business Name): PAYTON GROVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 S 86TH ST STE 101
LINCOLN NE
68526-9263
US

IV. Provider business mailing address

5600 ABBEY CT APT 93
LINCOLN NE
68505-3307
US

V. Phone/Fax

Practice location:
  • Phone: 402-782-1285
  • Fax:
Mailing address:
  • Phone: 402-782-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: