Healthcare Provider Details

I. General information

NPI: 1700634151
Provider Name (Legal Business Name): CHARITY WAITHERERO MAINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6107 S 159TH AVE
OMAHA NE
68135-6303
US

IV. Provider business mailing address

6107 S 159TH AVE
OMAHA NE
68135-6303
US

V. Phone/Fax

Practice location:
  • Phone: 531-203-9804
  • Fax:
Mailing address:
  • Phone: 531-203-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number86060
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: