Healthcare Provider Details

I. General information

NPI: 1376408773
Provider Name (Legal Business Name): JEAN YVON ANACIUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 N 101ST ST
OMAHA NE
68134-3710
US

IV. Provider business mailing address

4030 N 101ST ST
OMAHA NE
68134-3710
US

V. Phone/Fax

Practice location:
  • Phone: 402-591-1823
  • Fax:
Mailing address:
  • Phone:
  • 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: