Healthcare Provider Details

I. General information

NPI: 1063302834
Provider Name (Legal Business Name): MENGISTU KUWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 L ST
LINCOLN NE
68508-2509
US

IV. Provider business mailing address

3444 P ST
LINCOLN NE
68503-3325
US

V. Phone/Fax

Practice location:
  • Phone: 402-853-4332
  • Fax:
Mailing address:
  • Phone: 402-805-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: