Healthcare Provider Details

I. General information

NPI: 1003616640
Provider Name (Legal Business Name): TEADRANA KNOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1502 N 70TH AVE
OMAHA NE
68104-4621
US

IV. Provider business mailing address

4020 N 43RD ST
OMAHA NE
68111-2514
US

V. Phone/Fax

Practice location:
  • Phone: 402-213-8701
  • Fax:
Mailing address:
  • Phone: 402-213-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: