Healthcare Provider Details

I. General information

NPI: 1831045475
Provider Name (Legal Business Name): MANDY R WEBER-HAACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S 30TH ST
LINCOLN NE
68510-1427
US

IV. Provider business mailing address

621 S 30TH ST
LINCOLN NE
68510-1427
US

V. Phone/Fax

Practice location:
  • Phone: 402-540-9787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: