Healthcare Provider Details

I. General information

NPI: 1639066798
Provider Name (Legal Business Name): ROUT LAAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7316 N 19TH ST
LINCOLN NE
68521-5850
US

IV. Provider business mailing address

7316 N 19TH ST
LINCOLN NE
68521-5850
US

V. Phone/Fax

Practice location:
  • Phone: 402-217-7147
  • Fax:
Mailing address:
  • Phone: 402-217-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: