Healthcare Provider Details

I. General information

NPI: 1568377364
Provider Name (Legal Business Name): MARIA M CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 ELKCREST DR
LINCOLN NE
68516-1442
US

IV. Provider business mailing address

5820 ELKCREST DR
LINCOLN NE
68516-1442
US

V. Phone/Fax

Practice location:
  • Phone: 531-363-3261
  • Fax:
Mailing address:
  • Phone: 531-363-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: