Healthcare Provider Details

I. General information

NPI: 1982459749
Provider Name (Legal Business Name): NYERI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 SHAMROCK PLZ STE 200
OMAHA NE
68154-3537
US

IV. Provider business mailing address

17659 WEBER ST
BENNINGTON NE
68007-3346
US

V. Phone/Fax

Practice location:
  • Phone: 402-687-6665
  • Fax:
Mailing address:
  • Phone: 660-528-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN W GATERE
Title or Position: OWNER
Credential: DNP, MPH, APRN
Phone: 660-528-1439