Healthcare Provider Details

I. General information

NPI: 1144031949
Provider Name (Legal Business Name): MRS. LAUREL J NOVOTNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI NOVOTNY

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 N 130TH AVENUE CIR
OMAHA NE
68154-3627
US

IV. Provider business mailing address

1706 N 130TH AVENUE CIR
OMAHA NE
68154-3627
US

V. Phone/Fax

Practice location:
  • Phone: 402-980-9835
  • Fax: 402-980-9835
Mailing address:
  • Phone: 402-980-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: