Healthcare Provider Details

I. General information

NPI: 1669390985
Provider Name (Legal Business Name): ANDREA CLAUDETTE QUALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 N 40TH AVE
OMAHA NE
68111-2632
US

IV. Provider business mailing address

8003 MORRIS ST
OMAHA NE
68122-2045
US

V. Phone/Fax

Practice location:
  • Phone: 402-598-1406
  • Fax:
Mailing address:
  • Phone: 402-598-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: