Healthcare Provider Details

I. General information

NPI: 1679408132
Provider Name (Legal Business Name): SHABANI KILILWA MULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 POND CIR
LINCOLN NE
68512-3601
US

IV. Provider business mailing address

2121 POND CIR
LINCOLN NE
68512-3601
US

V. Phone/Fax

Practice location:
  • Phone: 402-730-9047
  • Fax:
Mailing address:
  • Phone: 402-730-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: