Healthcare Provider Details

I. General information

NPI: 1629883871
Provider Name (Legal Business Name): MR. CLINTON OHAMARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 OREGON TRL
LINCOLN NE
68521-3247
US

IV. Provider business mailing address

5801 HIDCOTE DR
LINCOLN NE
68516-5568
US

V. Phone/Fax

Practice location:
  • Phone: 402-840-8478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: