Healthcare Provider Details

I. General information

NPI: 1508799354
Provider Name (Legal Business Name): NATHANIEL SCOTT SOUZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 S 96TH ST
OMAHA NE
68127-1221
US

IV. Provider business mailing address

1702 FRANKLIN ST
BELLEVUE NE
68005-3454
US

V. Phone/Fax

Practice location:
  • Phone: 402-720-8404
  • Fax:
Mailing address:
  • Phone: 402-720-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: