Healthcare Provider Details

I. General information

NPI: 1689501363
Provider Name (Legal Business Name): JESSICA CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LIBRA DR STE 102
LINCOLN NE
68512-9628
US

IV. Provider business mailing address

1200 LIBRA DR STE 102
LINCOLN NE
68512-9628
US

V. Phone/Fax

Practice location:
  • Phone: 402-207-1050
  • Fax:
Mailing address:
  • Phone: 402-207-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: