Healthcare Provider Details

I. General information

NPI: 1609798271
Provider Name (Legal Business Name): ISAAC SPOTANSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 MAVERICK PLAZA
OMAHA NE
68182-0001
US

IV. Provider business mailing address

1493 AUGUSTA DR
SEWARD NE
68434-1433
US

V. Phone/Fax

Practice location:
  • Phone: 402-803-0665
  • Fax:
Mailing address:
  • Phone: 402-803-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: