Healthcare Provider Details

I. General information

NPI: 1124837653
Provider Name (Legal Business Name): CAMERON ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 HARTLEY ST
LINCOLN NE
68521-1731
US

IV. Provider business mailing address

1832 HARTLEY ST
LINCOLN NE
68521-1731
US

V. Phone/Fax

Practice location:
  • Phone: 402-992-6839
  • Fax:
Mailing address:
  • Phone: 402-992-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number163WH0200X
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: