Healthcare Provider Details

I. General information

NPI: 1639970312
Provider Name (Legal Business Name): ECUBED CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14441 DUPONT CT STE 101
OMAHA NE
68144-2107
US

IV. Provider business mailing address

9101 KILPATRICK PKWY
BENNINGTON NE
68007-3241
US

V. Phone/Fax

Practice location:
  • Phone: 402-830-0338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: STACEY M SAMUEL
Title or Position: OWNER
Credential: PA-C
Phone: 503-507-6921