Healthcare Provider Details

I. General information

NPI: 1265362388
Provider Name (Legal Business Name): HTEE HTAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6629 SPENCER ST
OMAHA NE
68104-3214
US

IV. Provider business mailing address

6629 SPENCER ST
OMAHA NE
68104-3214
US

V. Phone/Fax

Practice location:
  • Phone: 402-215-4208
  • Fax:
Mailing address:
  • Phone: 402-215-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: