Healthcare Provider Details

I. General information

NPI: 1043126956
Provider Name (Legal Business Name): LAMONTIE ANDERSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 BROWNE ST
OMAHA NE
68111-2053
US

IV. Provider business mailing address

11550 I ST STE 100
OMAHA NE
68137-1222
US

V. Phone/Fax

Practice location:
  • Phone: 402-498-4700
  • Fax:
Mailing address:
  • Phone: 402-498-4700
  • 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: