Healthcare Provider Details

I. General information

NPI: 1194640623
Provider Name (Legal Business Name): HARPER GRACE SIDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 N 14TH STRRET
LINCOLN NE
68521
US

IV. Provider business mailing address

5230 N 14TH ST
LINCOLN NE
68521-4006
US

V. Phone/Fax

Practice location:
  • Phone: 402-805-9868
  • Fax:
Mailing address:
  • Phone: 402-805-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: