Healthcare Provider Details

I. General information

NPI: 1376249755
Provider Name (Legal Business Name): BEATRES JINO MONDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

9306 BEMIS PLZ APT 1
OMAHA NE
68114-2453
US

V. Phone/Fax

Practice location:
  • Phone: 402-930-7611
  • Fax: 402-995-3034
Mailing address:
  • Phone: 402-591-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7817
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7817
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: