Healthcare Provider Details

I. General information

NPI: 1790697605
Provider Name (Legal Business Name): LUELLA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 OAKS LN
OMAHA NE
68137-2032
US

IV. Provider business mailing address

12656 WEIR ST APT 108
OMAHA NE
68137-1919
US

V. Phone/Fax

Practice location:
  • Phone: 402-896-9988
  • Fax:
Mailing address:
  • Phone: 402-896-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: