Healthcare Provider Details

I. General information

NPI: 1730006644
Provider Name (Legal Business Name): MS. CHARLES TONE MCCLENDON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 AERO DR
LINCOLN NE
68516-1989
US

IV. Provider business mailing address

7300 S 89TH ST APT 2360
LINCOLN NE
68526-6526
US

V. Phone/Fax

Practice location:
  • Phone: 402-801-9143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberH13645311
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: