Healthcare Provider Details

I. General information

NPI: 1730008038
Provider Name (Legal Business Name): ANNUARITE CHANCELINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 N 75TH AVE # NEUSA
OMAHA NE
68114-1702
US

IV. Provider business mailing address

1512 N 75TH AVE # NEUSA
OMAHA NE
68114-1702
US

V. Phone/Fax

Practice location:
  • Phone: 402-401-1591
  • Fax:
Mailing address:
  • Phone: 402-401-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberH14165089
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: