Healthcare Provider Details

I. General information

NPI: 1891321790
Provider Name (Legal Business Name): CAWAB MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11060 OAK ST STE 6
OMAHA NE
68144-4244
US

IV. Provider business mailing address

11060 OAK ST STE 6
OMAHA NE
68144-4244
US

V. Phone/Fax

Practice location:
  • Phone: 402-889-3633
  • Fax: 531-375-3755
Mailing address:
  • Phone: 402-889-3633
  • Fax: 531-375-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBELRY K ANDERSON
Title or Position: OWNER
Credential: PMHNP
Phone: 402-889-3633