Healthcare Provider Details

I. General information

NPI: 1932031457
Provider Name (Legal Business Name): TARA ERNESTINE DORSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 INDIAN HILLS DR
OMAHA NE
68114-4070
US

IV. Provider business mailing address

1740 N 84TH TER
OMAHA NE
68114-2909
US

V. Phone/Fax

Practice location:
  • Phone: 402-505-0549
  • Fax:
Mailing address:
  • Phone: 402-505-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number94079
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: