Healthcare Provider Details

I. General information

NPI: 1538978184
Provider Name (Legal Business Name): BIANCA MARIE CHILDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6652 MAPLE ST
OMAHA NE
68104-3995
US

IV. Provider business mailing address

1141 S 30TH AVE APT 11
OMAHA NE
68105-2125
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-1122
  • Fax: 531-299-1137
Mailing address:
  • Phone: 531-299-1122
  • Fax: 531-299-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: