Healthcare Provider Details

I. General information

NPI: 1740095025
Provider Name (Legal Business Name): GISELLE MENDIETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 S 70TH ST STE 200
LINCOLN NE
68516-4275
US

IV. Provider business mailing address

4433 S 70TH ST STE 200
LINCOLN NE
68516-4275
US

V. Phone/Fax

Practice location:
  • Phone: 402-471-6400
  • Fax:
Mailing address:
  • Phone: 402-471-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: