Healthcare Provider Details

I. General information

NPI: 1285570432
Provider Name (Legal Business Name): AMIYAH D DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S 75TH ST
OMAHA NE
68114-4621
US

IV. Provider business mailing address

704 S 75TH ST
OMAHA NE
68114-4621
US

V. Phone/Fax

Practice location:
  • Phone: 402-556-5290
  • Fax: 402-552-9242
Mailing address:
  • Phone: 402-556-5290
  • Fax: 402-552-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: