Healthcare Provider Details

I. General information

NPI: 1740119668
Provider Name (Legal Business Name): EUGENE SKINNER PBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 N 42ND ST
OMAHA NE
68111-2548
US

IV. Provider business mailing address

3615 N 42ND ST
OMAHA NE
68111-2548
US

V. Phone/Fax

Practice location:
  • Phone: 402-706-5725
  • Fax:
Mailing address:
  • Phone: 402-706-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number63927
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: