Healthcare Provider Details

I. General information

NPI: 1649076720
Provider Name (Legal Business Name): NESHWAN KHERALLAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 N 28TH ST
LINCOLN NE
68503-1212
US

IV. Provider business mailing address

2223 N 28TH ST
LINCOLN NE
68503-1212
US

V. Phone/Fax

Practice location:
  • Phone: 402-418-1991
  • Fax:
Mailing address:
  • Phone: 402-418-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: