Healthcare Provider Details

I. General information

NPI: 1902775380
Provider Name (Legal Business Name): NYALIEP JOCK LUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 S 13TH ST
OMAHA NE
68108-3501
US

IV. Provider business mailing address

1207 S 13TH ST
OMAHA NE
68108-3501
US

V. Phone/Fax

Practice location:
  • Phone: 531-255-7153
  • Fax:
Mailing address:
  • Phone: 531-255-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: