Healthcare Provider Details

I. General information

NPI: 1548176910
Provider Name (Legal Business Name): NICHOLAS KEITH ROTHLISBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 N 65TH ST
OMAHA NE
68104-3905
US

IV. Provider business mailing address

2335 N 65TH ST
OMAHA NE
68104-3905
US

V. Phone/Fax

Practice location:
  • Phone: 402-813-4651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberH14054916
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: