Healthcare Provider Details

I. General information

NPI: 1467317636
Provider Name (Legal Business Name): ETHAN JAMES OAKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 RAASCH DR STE 300
NORFOLK NE
68701-3175
US

IV. Provider business mailing address

2129 MORNINGSIDE RD APT 3605
FREMONT NE
68025-8910
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-3888
  • Fax:
Mailing address:
  • Phone: 402-379-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: