Healthcare Provider Details

I. General information

NPI: 1740088772
Provider Name (Legal Business Name): GWENDOLYN KNAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 BROWNE ST
OMAHA NE
68111-1829
US

IV. Provider business mailing address

4340 BROWNE ST
OMAHA NE
68111-1829
US

V. Phone/Fax

Practice location:
  • Phone: 402-813-0153
  • Fax:
Mailing address:
  • Phone: 402-813-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2450
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: